Discussion: Exercise Induced Asthma

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Discussion: Exercise Induced Asthma

Discussion: Exercise Induced Asthma

Discussion: Exercise Induced Asthma

Discussion: Exercise Induced Asthma

Module 10: Discussion A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today. He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. Patient also reports a history of exercise induced asthma and uses albuterol sulfate HFA as needed. On physical exam patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL.Strength lower extremities +5 and DTRs + 2.Left calf erythematous, edematous, warm and tender on palpation.Pulses 3+. Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis. Stat ultrasound of left leg to rule out DVT was ordered and read as normal CBC WNL Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L) BUN and Creatinine WNL A diagnosis of rhabdomyolysis was made. 1. Discuss the pathophysiology of acute renal failure in rhabdomyolysis.

Exercised-induced asthma is a narrowing of the airways in the lungs triggered by strenuous exercise. It causes shortness of breath, wheezing, coughing and other symptoms during or after exercise.

The preferred term for this condition is exercise-induced bronchoconstriction (brong-koh-kun-STRIK-shun). This term is more accurate because the exercise induces narrowing of airways (bronchoconstriction) but isn’t a root cause of asthma. Among people with asthma, exercise is likely just one of several factors that may trigger breathing difficulties.

Most people with exercise-induced bronchoconstriction can continue to exercise and remain active by treating the symptoms with common asthma medications and taking preventive measures.

Symptoms

Signs and symptoms of exercise-induced bronchoconstriction may begin during or soon after exercise. These symptoms may last for 60 minutes or longer if left untreated. The signs and symptoms may include:

  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness or pain
  • Fatigue during exercise
  • Poorer than expected athletic performance
  • Avoidance of activity (a sign primarily among young children)

When to see a doctor

See your doctor if you experience any signs or symptoms of exercise-induced bronchoconstriction. A number of conditions can cause similar symptoms, making it important to get a prompt and accurate diagnosis.

Get emergency medical treatment if symptoms are getting worse, such as:

  • Shortness of breath or wheezing that is quickly increasing, making it a struggle to breathe
  • No improvement even after using a prescription inhaler for asthma attacks

Causes

It’s not clear what causes exercise-induced bronchoconstriction. There may be more than one biological process involved. People with exercise-induced bronchoconstriction have inflammation and may have excess mucus production after strenuous exercise.

Risk factors

Exercise-induced bronchoconstriction is more likely to occur in:

  • People with asthma. About 90 percent of people with asthma have exercise-induced bronchoconstriction. However, the condition can occur in people without asthma too.
  • Elite athletes. Although anyone can experience exercise-induced bronchoconstriction, it’s more common in high-level athletes.

Factors that may increase the risk of the condition or act as triggers include:

  • Cold air
  • Dry air
  • Air pollution
  • Chlorine in swimming pools
  • Chemicals used with ice rink resurfacing equipment
  • Activities with extended periods of deep breathing, such as long-distance running, swimming or soccer

Complications

Exercise-induced bronchoconstriction that is not treated can result in:

  • A lack of beneficial exercise
  • Poor performance in activities you would otherwise enjoy
  • Serious or life-threatening breathing difficulties, particularly among people with poorly managed asthma
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