If your child often ends up watching his or her sports team from the sidelines because breathing during play is a struggle, he or she may be one of the more than 6 million children with asthma. Exercise is a common trigger for chronic asthma, and there is another condition called exercise-induced asthma, where people feel good during exercise but experience typical symptoms of asthma such as wheezing, cough and chest tightness or pain within about 10 minutes after finishing strenuous exercise.

Failure to diagnose either of these types of asthma can cause children, and adults, to skip out on the exercise they need for a healthy lifestyle. And in rare cases, untreated asthma can lead to death. Jack M. Becker, MD, chief of the section of allergy at St. Christopher's Hospital for Children in Philadelphia and his colleagues studied asthma death during sports in the study published in the February 2004 issue of the Journal of Allergy and Clinical Immunology. Below, Dr. Becker talks about the importance of recognizing and treating asthma so that these individuals can get out and exercise.

What is the difference between exercise-induced asthma and asthma triggered by exercise?
There's a huge difference between exercise-induced asthma and asthma that is triggered by exercise. Exercise-induced asthma is when within 10 minutes after completing your activity, you have a decrease in lung function and experience trouble breathing.

What the vast majority of the population has is not exercise-induced asthma, but asthma that is poorly controlled and therefore is triggered by activity. And, 90 percent of people with this form of asthma will be triggered by activity, and they will probably not get through the activity without having symptoms or signs of respiratory problems. So, the child who has to come off the soccer field after playing 10 minutes because he's wheezing doesn't have exercise-induced asthma. That's asthma that was triggered by activity.

What causes exercise-induced asthma?
What we believe (and this is just all theory) is that, when you're exercising, you're basically cooling and drying the airways, which leads to restricted air flow. Some 45 percent of athletes in the '96 Summer Olympics said they had asthma. Now that number is way too high for it to be caused by chronic asthma. That would infer that asthmatics are better athletes than non-asthmatics. So if you're talking about exercise-induced asthma, you're probably talking about a very competitive athlete who can train at extremely high levels.

Why is it important to distinguish between exercise-induced asthma and chronic asthma?
That's actually a huge issue because many physicians as well as family members don't appreciate the difference. So they're saying, "Oh, my kid just has exercise-induced asthma. And therefore all I need to do is use a rescue medication before he or she plays and they'll be fine." Where the truth is, what they may have is mild or moderate asthma that's being triggered every time they play, and they need long-term, preventative treatment.

Are there any other clues that it might be chronic asthma?
The vast majority of these children or adults, when you dig deep in their medical history, will keep a cough for a long time when they get a cold. The cold air will bother them a little bit. A cat or a dog may bother them, strong fumes may bother them. All those things are probably very subtle triggers that they don't recognize. But when you put it all together, you see chronic asthma.

What are strategies for avoiding asthma triggered by exercise?
If your chronic asthma is acting up because you've been sick or the weather is very cold, those are days probably shouldn't be doing significant physical activity.

Warming up and cooling down are very important for chronic asthma and exercise-induced asthma. Part of it is warming up and cooling down might make the airway less cool and dry. Part of it is that if you were to run one sprint, you may get very tight after that one sprint and your asthma may flare up, but for the next two or three hours, you might be fine because you've gotten over it. So a big part of the warm-up is a way to allow the body to react a little bit while you're warming up, not in the middle of your activity.

What medications can be used?
There are two kinds of medications. The rescue medication is either albuterol or pirbuterol. And that's an asthma medication that you will take either right before exercise or when you have symptoms and that provides a quick relief.

If people have chronic asthma that's triggered by activity, then they need to have their asthma controlled with preventative therapy. There's a whole host of medication, such as inhaled corticosteroids, antileukotriene medication and cromolyn, which depending on what the patient needs, will be right for them.

The other part of this, which is tremendously under-appreciated, is the significance of allergy in asthma. So when I see my patients with asthma and allergies, I'm aggressively treating the allergy part to try and get their nose clear so they can allow the air to be filtered and cleared.

Why did you conduct your study on asthma-related deaths during sports?
Part of the reason we did the study is, if you look in an average sports medicine book, they won't list asthma as a cause of potential death and they may not even touch on the subject at all.

We wanted people to realize that asthma attacks during sports is a big problem. If a child collapses while playing and has a cardiac issue, it usually makes the newspaper. But they don't cover Bobby coming off the field wheezing. In the state of Pennsylvania, for example, any school who wants to have a defibrillator can have one, but we can't get an asthma inhaler on every sideline, even though it's rare to have a cardiac problem in a school and far more common to have a child have an asthma attack on the playing field.

What is your advice to parents and coaches?
The big thing is that kids should go out and play, and we need to make sure their asthma is well enough controlled so they can. In 2002, 6.3 million under 18 had asthma. If you figure that 90 percent of those patients can have their asthma be triggered by activity, there are millions of kids who, in theory, will have their activity limited because of asthma. We recommend that coaches just check in with their players, "How are you doing? How are you breathing? Everything okay?" So if the child says, "Well, my asthma's acting up," maybe he can't play today. We try and tell trainers and parents that they have to treat asthma like they treat an injury.

Another responsibility is that they got to make sure they have rescue medication right there at the field. Kids have died trying to get their inhaler. Now I can't guarantee if they got their inhaler, they would live, but, clearly, not having it didn't help.

There actually is even some preliminary research that suggests part of the reason that asthma's on the rise is because we're getting less exercise. We need a certain amount of exercise to help our lungs develop at all ages. So my real goal is to get people out there exercising. We want them playing safely so that they can have a healthy lifestyle. And the only way we'll ever accomplish that is with a proper circle of communication between the parent, the child and the doctor.