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Paed Asthma – No worsening of symptoms

Evidence Summary
The published data from physical activity-based interventions varied widely in terms of the activity undertaken. This ranged from low intensity to high intensity in asthmatics with mild to moderate disease. In all of the studies published there has been no documented adverse effects on asthma control or occurrence of exacerbations within intervention-based groups – this included studies looking at swimming based activities. There has previously been a suggestion that chlorinated swimming pools could worsen asthma symptoms however none of the swimming studies demonstrated this.

Quality of Evidence
A – high quality evidence
Strength of Recommendation
1B, Strong recommendation, moderate quality evidence. Not all studies commented on a lack of adverse outcomes so their absence was presumed preventing a 1A recommendation.


In no published studies has there been any documented worsening of asthma symptoms or increase in exacerbations. These studies did not include severe asthmatics or those with significant co-morbidities. This included studies looking at a variety of physical activity intervention groups performing a wide range of activities, with different intensities and differing durations. This is reassuring and would suggest that if asthma symptoms worsen due to exercise it could indicate poorly controlled asthma rather than being due to the exercise itself.

Beggs, S., Y. C. Foong, H. C. Le, D. Noor, R. Wood-Baker and J. A. Walters (2013). “Swimming training for asthma in children and adolescents aged 18 years and under.” Paediatr Respir Rev 14(2): 96-97.
Carew, C. and D. W. Cox (2018). “Laps or lengths? The effects of different exercise programs on asthma control in children.” J Asthma 55(8): 877-881.
Font-Ribera, L., C. M. Villanueva, M. J. Nieuwenhuijsen, J. P. Zock, M. Kogevinas and J. Henderson (2011). “Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort.” Am J Respir Crit Care Med 183(5): 582-588.
Geiger, K. R. and N. Henschke (2015). “Swimming for children and adolescents with asthma.” Br J Sports Med 49(12): 835-836.
Silva, D., M. Couto, P. Moreira, P. Padrao, P. Santos, L. Delgado and A. Moreira (2013). “Physical training improves quality of life both in asthmatic children and their caregivers.” Ann Allergy Asthma Immunol 111(5): 427-428.
Zhang, Y. F. and L. D. Yang (2019). “Exercise training as an adjunctive therapy to montelukast in children with mild asthma: A randomized controlled trial.” Medicine (Baltimore) 98(2): e14046.