Asthma and Physical and Sports Education
One too many student s asthma s is exempt from PE classes. This reduces their activity and access to an essential school culture . The less practical asthma sufferer , the greater and earlier the shortness of breath is during exercise. Leaving him without activity is to run the risk of increasing his difficulties as he grows up. Sometimes intense exercise can cause a temporary narrowing of the airways. Between 80% and 90% of students with asthma experience difficulty breathing during vigorous exercise. The exercise-induced asthma may appear re the course of a lesson when he has never been detected in children before . Appropriate teaching allows students to participate at their level.
The e Expiratory Flow Pointe (DEP)
The breath measurement is a very useful indicator to allow an asthmatic student to practice a physical activity calmly. Indeed, it is difficult po ur one to locate him - even the intensity of his breathing. A measure of the " state of" respiratory student before his participation in EPS can be performed. The teacher can then adapt the pupil's tasks to the possibilities of the moment. This measure pe RMET possibly to announce a crisis ; the former rate piratory peak falling even before the signs of a crisis appear.
There are different forms of apparatus equipped with a cursor which moves along a graduated scale when one blows and stops when the speed of the blast is maximum. The Pointe Flow Meter (or peak flow) is the most common. The DEP is proportional to the size.
Average value in women : 400 to 500 ml / min
Average value for humans : 500 to 650 ml / min
These devices are quite accessible for schools : around 20 to 25 € in pharmacies
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Other electronic devices give more precise results with curves and calculations . The spirometer can also give other information useful for the management of his asthma.
These camera 's are quite expensive for schools and reserved to specialists : the order of 100 to 3000 € to order
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Q hen use :
In the event that a student with asthma is declared or if it is assumed that a student may well be asthmatic , the D E P measurement can be used :
At the start of the session, to determine the intensity of the asthma and suggest spo rtive situations accessible to the efforts that the pupil will have to provide ;
During the session, after certain tasks to detect the onset of a seizure and / or assess the impact of the exercise on the pupil's breath ;
At the end of the session, to prevent the occurrence of a post-exercise crisis.
Measuring the expiratory flow shortly after taking a bronchodilator makes it possible to test the effect of the drug before participating in the session (or following the session in the case of a seizure occurring during the course). Comparing the evolution of DEP measurements during PE with those taken on a daily basis or in periods when the student does not feel any discomfort allows us to see the importance of the impact of physical practice on his breathing.
C ow to use a PEF meter :
On the meter takes careful to put the cursor at the bottom of the graduated scale. Then, the student is asked to blow all at once, as hard and as fast as possible . We start again 3 times and we note the most important value.
How to use the results :
If the D E P is normal, that is to say equal (or greater) to the value taken under the conditions of good health of the asthmatic student, the student can participate with the other classmates without special precautions (if it is not to take into account : the climatic conditions, the type of effort…) . Between 80% and 100% of the reference value : this is the green zone , a sign of controlled asthma
If the measurement is less than the normal e in BEGIN t courses but remains between 50% and 80% , we can think about a light attack. This is the orange zone : the treatment must be reinforced . Taking a rapid and short-term bronchodilator (eg : ventoline) can stop or minimize respiratory discomfort to allow the session to be followed. However, the DEP must go above 80% after taking the drug. We can then use the results in the construction of a session. (Ex : if decrease in D E P by 10%, decrease the intensity of a run of duration proportionally as one would do with a MAS, change the group student to run at a more moderate pace, see change the situation by running the asthmatic student on an interval exercise that is less difficult than a continuous run).
If the D E P reading is less than 50% and does not go above 80% after taking medication, it is probably a severe attack. This is the red zone (danger) . It is better to stop any effort and warn the parents and / or help (nurse, doctor, firefighters…). Calmer then the student and find a resting position (usually sitting e ) pending assistance .
E n re Sume, if we were to remember ... :
When a teacher meets a student with asthma , certain precautions are necessary to reduce the risk of allergies :
Find out about genes before the session (nocturnal crisis, fatigue, cold, etc.) ,
Taking into account the environment of the course : gym ventilation, weather, pollution, pollen ... ,
Check the taking of a treatment before the start of the session ,
Measure the Peak Expiratory Flow if you have the necessary equipment,
Set up a warm-up that will improve exercise tolerance
Warm-up possible : - alternating low intensity walking and running (5 min)
- stretching
- dynamic jumps and / or races (30sec)
- rest (1 min)
- repeat these exercises 2 or 3 times in a row
Encourage nasal breathing
Observe the appearance of respiratory disorders (after warming up, 5 to 10 minutes after exercise, after session, etc.) ,
Taking treatment and / or adapting the exercise according to the degree of discomfort,
Gradually stop the effort
Drink before, during and after exercise (even if the student is not thirsty) because dehydration can cause bronchospasm
For information, research assumes nt he is a link between the asthma and the e Constant wear shoes poor quality (some sneakers ...) . Because of bad will train soles in ta af faissement the arch therefore an imbalance of static and therefore distort the chest compressing bronchi ... To confirm ! But informing pupils and / or parents about prevention costs nothing ...
In conclusion :
There are no lessons guys, see e specific exercise to the student with asthma because attacks are unpredictable s and variable . A pupil can participate well without feeling any discomfort and the next time encounter difficulties even when the weather conditions are good and the session is easier. Research and experience have shown that short and intense exercises are better supported than long efforts. But we note that a progressive groundwork allows to develop the respiratory capacities of the asthma sufferer. The practice of a physical activity improves the tolerance to the effort and reduces the appearance of a dyspnea of exertion in the long term And it is clear that a good number of champions have asthma.
It is therefore up to each teacher to adapt according to the evolution of the child's disorder. He has a role to play in helping the pupil to “ control ” his handicap. A better knowledge of it, progressive physical work, comfort when necessary will encourage the asthmatic child not to fear his difficulties , nor to build an image that is sometimes devaluing his physical condition . This attention and this work will in many cases avoid stress which is often an aggravating factor of the crisis encountered. The student will learn to differentiate normal post- exercise hyperventilation from an asthmatic attack . He will know how to respond correctly alone and / or with the help of the teacher to his handicap. This preventive approach to activity , carried out by a teacher with the student , is likely to break the “ paralyzing ” image of physical activity.
The student no longer suffers asthma but becomes responsible in the sense that it will create conditions for the active integration in practice EPS.
Certain endurance activities such as running are more likely to cause bronchial constriction on exertion. Team sports with a succession of efforts " violate s " can also trigger seizures. Swimming, because of its humid environment, would expose the asthmatic child to attacks less (except for those allergic to chlorine of course …). Horse riding is often banned due to allergenic factors linked to horses and their environment. Also be careful, the practice of scuba diving is still prohibited.
Cold and / or polluted air can trigger a crisis more easily than hot and / or humid air. This is why in our region (Paris and its surroundings), the peaks of pollution should be monitored during our practice with asthmatic students . For teachers who have very sensitive asthmatics in their course, you can consult the pollution index and forecasts on www.air p arif.asso.fr as well as the importance of pollen in the air in Paris and its surroundings. . Since the law Lepage (1996), alerts can be issued 're on the air quality, then the caution ...
exercise- induced asthma (APE)
Two theories appear to explain what the generally referred : induced asthma or asthma * Post Exercise.
The loss of water during exercise causes the bronchi to dry up, resulting in irritation and secretion of substances responsible for constricting the bronchi
The passage of " hot - cold - hot " air : the large supply of air during exercise has the effect of cooling the bronchi. Once the effort is over, the dilation of the blood vessels brings about a flow of blood which then quickly warms the lining of the bronchi. This variation in temperature in the respiratory tract would have the effect of releasing substances responsible for constricting the bronchi.
In asthmatic students, signs ' u n EPAs are often visible . However, there may be subtle symptoms. Systematic cough after activity, discomfort or pain in the chest, strong shortness of breath, sensitivity to cold air, difficulty running but not swimming… Not everything is necessarily asthma, but reporting these signs to parents for example can sometimes help to diagnose an APE and treat it appropriately. Otherwise, the asthmatic student will learn to limit his exercise to avoid symptoms and unpleasant sensations.
* We also say Bronchospasm induced by exercise: BIE. This term is more appropriate (but less used in our profession) because most often people who present with " asthma on effort " already have asthma. Exercise being an additional trigger . B ronchospasm post exercise : BPE also exists .
When does exercise- induced asthma ( APE ) occur
First phase called early and which is the most severe . The EPA may begin during the year (usually 10- 15 minutes , sometimes faster for children ) but often , this phase begins when the exercise period is over. The EPA occurs in 6 to 8 minutes depending on the intensity of the effort to achieve its up to 5A 10 minutes after training. It stops on its own between 30 to 60 minutes .
The EPA is defined as a decrease of at least 15% of the volume expiratory maximum / second (FEV) or peak expiratory flow rate occurring at approximately 10 minutes after strenuous exercise (60-85% VOmax).
Second so-called refractory phase (" grace period), after the onset of APE . I s there is usually a period of 30 to 90 minutes where bronchospasm is almost absent or missing. The student can participate again and sometimes with a lot of intensity.
Third so-called late phase, less severe. It may or may not occur with asthma symptoms that appear 12 to 16 hours after exercise and dissipates nt within 24 hours.
Prevent exercise- induced asthma ( APE )
In most cases, asthma can be controlled even during exercise, such as taking medication before and during the onset of symptoms.
A careful practice can prevent the onset of asthma attacks , in many cases , by respecting a few principles :
- warm up gradually to slowly prepare the respiratory tract . (Some asthmatic athletes trigger an APE during warm-up in order to take advantage of the refractory period during competition. However, I do not think this method is suitable for a student)
- Breathe through your nose… when possible because it is difficult to do so during an exercise. The advantage is to humidify the air before it reaches the bronchi.
- Limit intensive motor tasks when the air is cold and dry.
- Give priority to in-kind efforts rather than in an urban environment… when possible. (however, beware of pollen in nature in spring).
Aerobic activity is to be taken care of, but not to be avoided. E lle allows students regular use of his respiratory capacity (thus develop) and promotes personal management of asthma. The type, intensity and duration of the effort must be adapted to the pupil's responses .
The consideration of various provocative factors of asthma in the environment of the practice of students , often prevents any incident wheezing. Exercise tolerance levels vary in children with asthma. A personalized and adapted teaching will allow the student to learn to find his rhythm to participate in the activities which are at their level.
However, even under ideal conditions, strenuous exercise can cause AP E in some children. Common sense prevails.
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