Thank you to all who responded to my question about
sports induce asthma. I have good news, she isn't
going to play softball or run track and her parents
are going to try to find the right doctor this time.
Here is my origional question and a list of responses.


I have a high school alto with sports induced asthma.
She has a beautiful voice.  When she last sang for me
she was not involved in any sports and the voice was
fine.  Today she sang and was very airy.  She started
running for softball this week.  I asked her about
inhalers and what treatment she is on.  She said she
has been to several doctors and nothing seems to help.

 After she runs she will cough for the rest of the
night and has a feeling of not being able to get a
good breath.  She said she could not complete a phrase

in choir today. Have any of you encountered this?  Do
you have any suggestions? She is a wonderful kid who
has never had any problems for me before.  I didn't
notice a problem during volleyball. We have a league
contest Tuesday and she will not fare well with this
airy sound. Thank you in advance for your help.  I
will compile a list of responses.

Wendi Bogard
wendibogard(a)yahoo.com
Basehor-Linwood HS
Basehor, KS
_______________________________________________________I
read your question that you posted on the choral list
and I have to say that I know how your student feels.
i am a thrid year voice major, and I suffer from
severe asthma. I have a few suggestions for you that
may
help. Maybe if you worked with your student on a
schedule where she would sing on days when she isn't
playing sports this will give her lungs time to adjust
to the extra stress that is being put on them. Also I
know that it may seem that playing sports may be doing
more harm then good, but it's quite the opposite
getting exercise is good for people with asthma they
just have to know not to go overboard with it. As for
sthma medications.. ask her is she is using an air
chamber with her inhalers, this helps get the
medication which is in the inhalers straight down in
your lungs instead of stoping at the back of your
throat. if she is on steriod inhalers these dry you
out, so make sure she is drinking lots of water.
And the last thing is that if she is a severe
asthmatic, maybe she needs to look into asthma
medication that is the form of a pill which you
take twice a day, there are several different kinds
which are availible and they are better for you then
inhalers. I hope that this helps you at least in some
way.

______________________________________________________

I am a singer living with asthma. I am 40 years
old,
was diagnosed eleven years ago, in between
pregnancies. Outdoor sports are more difficult
participation for an asthmatic; prevention of
attacks is critical. You know the "an ounce of
prevention is worth a pound of cure" adage? It is
soooo true. If she is participating in sports with
asthma, she must be under a doctor's vigilant care.

My asthma is very serious. Without prescription
meds, I would not be alive today. I take a
cortico-steroid inhaler called Flo-vent twice a day
to manage the asthma, and I keep a Proventil inhaler
in my purse in case of trouble. The steroid is the
manager; you take it when you are feeling great - -
- always, always, ALWAYS - - so that you won't feel
bad! I take two puffs of the Proventil prior to my
INDOOR workouts and also if I encounter anything
that might generate problems, i.e. a smoky room,
animal dander. In Atlanta's upcoming high pollen
season, I may need to make some alterations, but my
doctor and I will make those decisions together.

I am a mezzo-soprano soloist, and a pretty good one.
I do not allow asthma to interfere with what I love
to do, much less with my daily life.
Check with your student regarding hay fever. If she
has allergies induced by airborn subtances like
dust, pollen, molds, tobacco smoke, etc. she might
want to investigate a product called Flo-nase, a
product that has really contributed to my normal
breathing.

If softball interferes with her breathing, she
should not do it! We're talking health, here.
Singing has NEVER interfered with my breathing, and
my condition does not affect my vocal quality
because I make good and sure that I am my own health
manager, in terms of rest, nutrition, and physical
activity.

Please feel free to print this out and give a copy
of it to your student's family.
_______________________________________________________I
have had asthma all of my life. My guess is that she
hasn't yet found the reight doctor. She needs to find
an asthma and allergy specialist. Mine has done
wonders for me. New drugs such as Singulair can give
amazing relief, often without use of inhalers.
_______________________________________________________
I am not responded to tha asthma part as much as to
the coughing. If she is coughing a great deal, every
time she coughs, she slams her vocal chords together,
which results in swelling, which can ultimately cause
laryngitis, but also makes it difficult to get the
chords to vibrate, which takes more air.

Probably, she shoudl lay off singing when she has been
coughing and not try to force her voice out. It is
possible to do further damage.

_______________________________________________________
Sorry to hear the bad news about your alto. How old is
she?  Is she in the puberty stage?  Did you seek the
advice of an ENT? In any case, I hope that she will be
well soon.  However, in my opinion, the sport she
chose to indulge in simply does not go with singing. 
In fact you confirmed it yourself: When she last sang
for me she was not involved in any sports and the
voice was fine. I believe that she has to choose,
either one or the other.  Singing discipline requies
many sacrifices and this is one of them.  If she loves
to sing and wishes to make a career out of it then she
has to decide to adheer to the rules.  If this is too
much for her, then she should give  up singing and
play at sports as much as she likes.  Pity to abandon
such a presious gift.  A beautiful voice should be
nourished and cared for. I understand your predicament
and know your feeling.

_______________________________________________________
Hi,

I´m a doctor and also sing in a choir. I believe what
your student should dois follow her doctor´s
recommendations. Exercise-induced asthma is one of
the ways os presentation of asthma, and she should use
her inhaler before starting sports, that is supposed
to be enough, however if that alone does not work,
there are other kind of inhalers (corticosteroids) and

recently some new pills that can be added to her
therapy. Well she has to attend a Neumologist and
review her case thoroughly. I also have asthma (mild
to moderate) and I have not got any trouble singing
for a long time.
_______________________________________________________
She might try wearing one of those "face masks" like
surgeons, and road crews wear... for surgeons it's to
keep germs away, for road crews, it's to
keep grass clippings, mold, dust, etc from getting in
their lungs. Maybe it's the cold air on her vocal
cords that's getting things stirred up.

If she's been to lots of doctors, and they aren't
finding anything wrong, maybe it's also just the
stress of running - is she in pretty good shape
otherwise?

Sometimes people have to make choices :)
_______________________________________________________
The problem you have with your singer could be several
things. First of all, my daughter and I have exercise
induced asthma so I know what is involved. I am a
choirdirector/organist and I do have my asthma under
control. BUT, I am on a strict regimen of preventive
medications and also rescue if I need it. I have
found that my daughter is not very good about taking
her medicines (even though most of the time she says
she takes it) and also has problems. I cannot impress
on her enough the importance of following to the
letter the doctors orders and the seriousness of this
disease.

An asthma patient can do sports and sing well, IF, she
has a good doctor and follows the strict guidelines of
taking the medications. I may be wrong, but I suspect
this could be her problem even if she won't admit it!
If she doesn't have her asthma under control she
obviously shouldn't be in sports until it is under
control. Maybe a heart to heart talk with the parents
will shed some light on this. I know this is hard on
kids and I can speak from experience with my own
daughter. She was embarrassed and didn't want anyone
to know she had this illness. I can only assume most
teenagers would either be in denial or feel
embarrassed.

In addition I can also tell you that the inhalers can
cause a slight soreness in the throat, especially if
the mouth and throat isn't rinsed well after taking
the medication. I used my rescue inhaler BEFORE my
voice lessons and also drank plenty of water ( a must
for asthma ) before, during, and after singing. I
found this to be helpful to sing longer phrases with a
clearer tone.

I hope this gives you some help or at least some
direction to look for a solution. I can sympathize
with your student and I sincerely hope she is truthful
about her doctor visits and taking her medications for
her own health and well-being.

Let me know what you find out in your investigation.
I very much would like to know if your student is on
the right track!
_______________________________________________________
I have a son with asthma and I am here to tell you
that this girl needs to find a decent pulmonologist
and get some decent medication which is effective.
There is no need for her to have such symptoms and the
fact that she has them and they are not being
monitored by a physician is, quite frankly, scary. I
lost a good friend in high school who did not get
treated for her asthma soon enough and I have never
forgotten it. People die every day from this
condition.

Asthma protocol has improved so much over the last
five years alone that there is simply no truth to her
statement that she cannot find relief. She hasn't
tried. She needs to realize that she could die if she
doesn't. She also needs to be assured that good
asthma management these days is very easy and
effective, and doesn't necessarily mean dependence
upon a multitude of
drugs and nebulizer treatments.

I urge you to find out from her parents or a school
counselor what treatment she has been exposed to and
what she could do. My son is now on a simple inhaled
steroid once a day and has been symptom free for
almost a year. There ARE medications out there which
are very effective.

Also, I don't know about the weather there, but this
is high pollen season in Georgia, so that could be
complicating her symptoms if she is allergic.

As far as her singing is concerned, there are many
fine singers who have asthma and it can cause problems
when it is active. But again, newer protocols have
radically improved and there is simply no reason to go

untreated in this day.

Truly, get this child some help.
_______________________________________________________
I showed your query to a PE colleague who sufferes
from a similar
problem. She mentioned she takes 2 puffs off her
inhaler 30 minutes before any exercise.
She also questioned the girls cardio-vascular fitness.
Maybe regular exercisewould help in the long-run? (no
pun intended!)
_______________________________________________________
I have asthma. If she's coughing after she's exerting
herself physically, she's not controlling her asthma
and that's VERY dangerous.

She needs to be on several things:

Singlair (tablet) or Proventil (repitabs) to help
control inflamation. I really like the
Singulair....it doesn't give me the jitters.

AND

Flovent (inhaler) or Asthmacort (inhaler) also to help
control inflamation. These sprays ARE NOT RESCUE
inhalers and won't help an accute attack. I REALLY
like flovent, it cuts down a lot on my resuce inhaler
use. These are both 12 hour sprays.

AND

Proventil/Albuterol/Ventolin (all the same medicine
but each is made by a different company) - to control
accute attacks. She should take 2 sprays about 30
minutes before she runs/excercises.

If she has any nasal drainage, she should be on an
interanl decongestent and/or antihistime (depending on
her allergies. There are lots of choices. My
favorite nasal spray is Flonase. I take Claritin-D
tablets as well. For sprays, she could consider
Beconase, Vansonase (sp?) and there are others. For
an internal medication (yes, she needs to be on both)
there Seldane, Seldane-D, Claritin, Claritin-D,
Allegra, and many others.

Asthma is not a problem for me. It shouldn't be for
your student. I strongly believe she is not being
treated correctly if she's having that much trouble.
She's really asking for it if she doesn't take
control.
She's taking a calculated risk with not only her
health and singing voice, but with her LIFE.

Please feel free to contact me if you or your student
have any questions. I may not be able to answer them
all, but I can probably direct you to someone who can.

_______________________________________________________
Sounds a lot like me. Asthma is deadly on the voice.
You might suggest to the parents that she see an
allergist. My asthma was misdiagnosed as "sport
induced" and after years of suffering with asthma,
developing nodes and ruining my sinuses to the point
of needing surgery twice, I was sent to an allergist.
It was the best advice anyone ever gave me.
_______________________________________________________
Asthma is a very complicated disease process. A good
pulmonary specialist should be able to help her. She
should NOT be seeing a family practitioner who
probably does not know about the latest treatments.
The latest
treatments are long-term bronchodialators and inhaled
steroidial treaments. i.e., Serevent and Flovent
respectively. I have found them very
effective after years of struggle.
_______________________________________________________
With the stressful way we breath during singing (and I
use stressful as it relates to an asthmatic) a student
with "sport's induced asthma" will also be triggered
with singing or instrument playing. "Sport's induced
asthma" is called that because the person is having a
stressed intake and out put of air which causes the
asthma. (I am obviously leaving out a lot of medical
stuff here:>) The same relfex of activity is felt
during singing.

I ended up in vocal music many years ago because of my
asthma. Correct breathing, and not shallow, is
essential, but also impossible if the airway is
constricting with the attack.

Here are a few suggestions on how to approach this
problem. This child needs a pulmonary specialist
doctor. Have you talked to her parents about your
concerns and told them what you have seen and heard.
If this goes unattended it could spell disaster. Is
the coach in the school system? Can you approach
him/her? Is there a nurse in your school system? Has
the gym teacher seen this?
_______________________________________________________
You did not make it clear what, if any, medicines or
inhalers your singeris currently taking. But, in a
way, it doesn't matter.

Either her doctor was incompetent, or she is really
worse now (asthma canhave a very varying course), or
she maybe garbled the recommendations of the doctor--I
find it hard to believe that any physician would leave
a patient with the impression that "nothing seems to
help."

She needs to return to her current doctor or find
another doctor, now that her symptoms are worse.
Although asthma is a very common problem and any
primary care physician should be able to treat it, a
specialist such as an allergist or pulmonologist would
be great. There are a variety of treatment options,
and she should not have to cough all night!

Her airy tone, by the way, is almost certainly due to
all that
post-exertional coughing, which causes vocal cord
swelling (laryngealedema). Asthma does not directly
involve the larynx. Part of her problem in making it
through a phrase might be due to the accompanying
inefficientvocal production, and not just asthma.
Treatment for her cord swelling includes: 1) cough
suppression (treating the exertional asthma); 2) good
hydration through plenty of fluids--avoid caffeine;
and 3) vocal rest--a performance Tuesday seems overly
optimistic, even given the remarkable recuperative
powers of the young.

I hope this helps. Let me know if more questions
arise. Get her to a doctor!
_______________________________________________________
I have a student with asthma induced by any serious
exertion -- her answer is to get regular exercise
(walking mainly) but not to be involved in sports.
Much of what happens in PE class is out of bounds for
her, too, but she's in good shape and sings fine as
long as she watches her step, so to speak. I'm
sure she would be a basket case, and singing-disabled,
were she to do the workouts needed for a sport. Has
your student thought this through?

_______________________________________________________
Accupuncture will cure her of her asthma. Any good
accupuncturists in the area? I can personally attest
to its success.
_______________________________________________________
Hummmm. Have I ever encountered this? Well, yes. I
am an asthmatic.

I do not have "exercise induced asthma" in the
strictest sense. But exercise can certainly aggravate
my condition. Also I did not have asthma as a child.
I am now 56. My first full blown asthma attack was at
about age 23-24.

Asthma, you must remember, is an over reaction of the
body to foreign pathogens. Dust, pollens or whatever
the body is sensitive to, including different air
temperatures, eg. warm then cold air. Lung tissue
swells, particularly in the aureoles of the lungs.
This is critical at the capillary level where the
oxygen replenishes the blood and exchanges with carbon
dioxide. You are literally strangling from lack of
oxygen. Two reactions are usually happening at once.
A building of mucous and a constricting of
the aureoles, usually trapping the mucous in tight
little balls, which also keep the air from contacting
the thinnest tissue where oxygen is exchanged. More
strangling! Then comes more struggling to breath,
elevated blood pressure, more swelling, etc, etc.
Ugly spiral. Coughing is an effort to dislodge the
trapped mucous. And she is absolutely right when she
says she feels like she can't get a good breath.

Several points of importance.

1. Running, particularly out of doors, aggravates the
devil out of the condition if not fully medicated in
advance.
2. Please see additional doctors.
3. Medications are usually most effective in
combinations. A) A bronchodilator(inhaler) to loosen
the aureoles, B) A chortico steroid(inhaler) to
reduce the swelling, C) Some method of controlling
the sensitivity to pathogens eg. Theochron(tablet) in
a sustained release dose, or other similar
medications.
4. She might also improve from a respiratory therapy
such as a nebulization with Albuterol Sulfate. That's
probably more medicine than you ever wanted to know.

She needs to see a smarter doctor. She needs to
reduce her running. (Volleyball is usually limited
here, and indoors [temperature controlled air]). If
you listen carefully to her airy sound you may detect
both a
"rattle" of the lungs and a wheeze or whistle in her
breath. She should stay indoors past her performance
competition and maintain a calm, relaxed demeanor.
Asthma can also be psychologically triggered.

Lastly, because of diminished air capacity she may
need creative suggestions from you on phrasing to
accommodate limited volume of air.

I'm not a doctor, just a director, musican, and
patient.
_______________________________________________________
It seems very simple, but when she is running, make
sure she keeps hydrated. I know it is difficult
during outdoor track practice's but I have somewhat of
a similar problem and after no doctor's could suggest
anything - I listened to the seemingly universal
advice - Drink lots of water! Best of Luck
_______________________________________________________
My 10 year old daughter has had asthma for about 4 or
so years, so it distresses me greatly to hear you
speak of anyone (singer/athelete or not) who has this
condition and says she has been to several doctors and
nothing seems to help. As a matter of fact, my
daughter first developed asthma with the symptoms you
describe (coughing, etc.) and I can tell you it is
potentially VERY serious, and should be treated as
such. I don't mean to imply that your student isn't
treating it seriously, but there is so much great
medicine for asthma that if she's not getting results,
she needs to see another Doc. There's Singular,
Albuterol, and all kinds of other stuff that
effectively cures the problem... In any case, don't
leave this unattended. Good Luck
_______________________________________________________
I have this same condition, though not as severe. I
was diagnosed with cold weather, exercise induced
asthma. I take one breath of Proventil (albuteral)
about 15 minutes before exercising. The only side
effect I experience is a slightly higher pulse when
the medication is working.

I too have a student who struggle with a similar
condition. I asked her to tell her doctor that she is
a singer and explain her troubles. Between
reinforcing her breathing technique and adjusting the
amount and type of her medication, she is slowly
gaining back her upper register.

Good luck...you hate to discourage young, talented
singers!

_______________________________________________________
My husband is asthmatic. If you didn't find the
problem during volleyball, it may be that the problem
results from the grass or dirt on the softball field
and is, in fact, an allergy which should be treated as
one. There are lot of very good new medications and
she should see a pulmonary specialist or an allergy
specialist ASAP.
_______________________________________________________
Tough situation. It sounds obvious that it is the
outdoors--mold, spoors, dust, pollen, whatever--that's
the problem, if she's been all right with volleyball.

There's a time in life to try everything you can, find
out how you like it, find out whether you're any good
at it. Incoming Freshmen here at Virginia Tech are
told that the average student changes majors 2.7
times, or something like that! And since Title IX has
really kicked in and girls are actually getting a
chance to experience serious athletics, they're
finding some of the same problems boys have always
had.

There's also a time to decide that you're serious
about something inparticular, that you can't do
everything, and that you have to protect yourself from
things that might destroy any chance you might have to
continue with the thing you're serious about. Singers
should not cheerlead, or work in places where they
have to shout continuously over loud background noise,
or put themselves into situations where asthma or
other complications can be exacerbated. Violinists
should not play rugby or softball or other sports
where a finger could be broken or permanently
disabled. Pianists can't afford to lose the use of
very many body
parts, and organists even fewer!

All you can do is try to counsel this student. If she
loves softball and decides to continue, the tradeoff
will be a loss of her ability to sing beautifully and
to use her talent to reach out to others and perhaps
make their lives better. More immediately it will be
a loss of solo opportunities, or perhaps even of
participation in music if it gets even worse. But she
has to make the decision. You can't make it for her.

All you can do is make sure she understands the
alternatives and the consequences of her decision.

Best of luck both to you and to your student.
_______________________________________________________
Was the running done outside? If so, that accounts
for the difference in reactions, assuming the
volleyball was done indoors. Also, unless they ran
wind sprints during volleyball practice, playing
volleyball would not require the sustained type of
heavy breathing which running does. I am well-versed
in the problems
connected with asthma, its effects on breathing, and
the implications on singing, having a son who nearly
died as an infant from broncial asthma. I have had
many private voice students and choir members who
faced the same dilema. If all the medical solutions
have been explored, there is no solution short of the
student abstaining from the activities which produce
the problem or giving up singing during the time those
activities take priority.
_______________________________________________________
I have some information and experience with this issue
both personally andas a paramedic.

Asthma induced by physical activity is not a strange
or rare event. Many people have such problems. In
fact, cold air often makes it even worse. But it is
treatable. One important thing for her to do would be
to have a complete respiratory evaluation by a
competent specialist. It is possible that she is on
some medication that causes or contributes to this
asthma. For example, there is a large class of drugs
called beta blockers and other drugs which can cause
asthma or constriction in the airways. Sometimes
adjustment of the dose or a different medication needs
to be considered.

It is quite likely that the medical treatment will
involve the use of an inhaler before she runs or
otherwise exercises. Also using humidifiers at home
may help some. It can be treated as I said and the
most important thing you can do for her is to be sure
she has received proper medical evaluation as to the
cause. I would personally encourage her sports
activities
unless the asthma becomes much more severe than you
describe.

If she can abstain from running this week before her
contest it would probably be the best. But if she can
not, encourage her to rest her voice otherwise, drink
plenty of fluids and do the best she can.

I hope this helps.
_______________________________________________________


















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