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36 PULMONARY
Carrie A Jaworski, MDINTRODUCTION•Patients with pulmonary disorders can benefit greatly
from exercise when their disease process is under
proper control.
•Awareness of when and when not to participate as
well as the ability to use pharmacologic agents and
environmental controls greatly enhances one’s ability
to participate safely.ASTHMA- Asthma is a pulmonary disorder characterized by
chronic inflammation of the airways leading to
bronchial hyperreactivity. While in the past, asthmat-
ics were discouraged from exercise, today it is recog-
nized that regular exercise can reduce airway
reactivity and decrease medication use (Disabella and
Sherman, 1998). - Approximately 17 million adults and 5 million chil-
dren in the United States have chronic asthma (NIH,
1997). - The National Heart, Lung, and Blood Institute
(NHLBI) has set forth guidelines on the diagnosis and
management of asthma in an effort known as the
National Asthma Education and Prevention Program
(NAEPP). This program is evidence-based and rou-
tinely updates its recommendations based on the
newest research. See NHLBI website for most recent
recommendations @www.NHLBI.org.
DIAGNOSIS OF ASTHMA- History or presence of episodic symptoms of airflow
obstruction such as wheezing, chest tightness, short-
ness of breath, or cough. Absence of symptoms at
time of examination does not exclude diagnosis. - Airflow obstruction needs to be at least partially
reversible demonstrated through the use of spirometry.
First establish airflow obstruction: FEV 1 <80% pre-
dicted and FEV 1 /FVC <65% or below the lower limit
of normal. Then establish reversibility by an FEV 1
increase of ≥12% and at least 200 mL after using a
short-acting inhaled beta2-agonist. (FEV 1 =Forced
expiratory volume in 1 s; FVC =Forced vital capacity)
(NIH, 1997).