soccerQ: “My 16-year-old daughter’s asthma is getting worse with exercise. We want to increase her lung capacity to keep her lungs strong, but she can’t do aerobic exercise without her chest tightening up. She is taking medications for her asthma and allergies and we are planning to try allergy shots. What else can we do?”

Martha White, MD: If your daughter is experiencing chest tightness with exercise, you should first check with your doctor about using an albuterol inhaler 15-30 minutes before exercise. This can help prevent exercise-induced bronchospasm (EIB) symptoms in many individuals.

Review your daughter’s inhaler technique with her doctor to be sure that she is using the device effectively; otherwise a lot of the medication dose can be lost. I’ve seen a number of people who were having problems despite taking all the right medications, but who were much better after adding a holding chamber and learning to use the inhaler correctly.

I think you’re on the right track with starting allergy shots. Allergy shots work by making the body less allergic over time and offer the person with allergic asthma the best chance of improving to the point where medications can be greatly reduced, or possibly eliminated.

You’re also on the right track by encouraging regular exercise. Exercise doesn’t actually change lung function, but it can enhance how efficiently we use oxygen. Thus, a person who is in good physical shape feels less short of breath than a person in poor physical shape.

What’s more, lack of exercise can lead to obesity, which can make asthma worse and less responsive to medication. A disproportionate number of children with asthma are overweight, and it’s not clear whether the obesity leads to asthma, or more likely, whether the child notices shortness of breath with exercise and slowly turns into a couch potato to avoid breathing problems.

Martha White, MD, FACAAI, is a board-certified allergist at the Institute of Asthma and Allergy in Wheaton, Md., a member of The Network’s Board of Directors, an Allergy & Asthma Network medical editor since 1985 and a fellow of the American College of Allergy, Asthma & Immunology.

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