The Asthma, PDA and HMS Challenge

To swim or not to swim… that’s the question.

When you combine two or more health issues that work against each other, things become tricky.

Like asthma with PDA (Pathological Demand Avoidance, or more accurately: Pervasive Drive for Autonomy).

When your PDA brain shouts ‘don’t YOU tell me what to do!’ or tries to negotiate with you constantly to get out of taking your inhaler when your body is wheezing. It’s a tough gig.

And then there’s the advice. Exercise is good for your asthma. But what if exercise makes you feel worse and your PDA brain won’t let you take (inhaler) precautions? After all, why do you want to do something about it if it’s not even there yet? And… why would I exercise (which I know makes me feel worse) if I can just sit here, which I know doesn’t make me feel worse. Obvious choice.

Of course there is a future concern, because doing less (or nothing) physically will have implications on your fitness and overall well being, but that’s too abstract for the brain to take into account. The NOW seems more important.

If we then throw another condition in the mix, like Hypermobility Syndrome Disorder (HSD), it gets even more interesting. Now we’re looking at advice that requires exercise again, but this time to strengthen the muscles so that it can help the weak connective tissue to do its job. But this exercise isn’t just any exercise. The joints shouldn’t overstretch, which they ‘want’ to do when the connective tissue is weak. And this overstretching can and will lead to subluxations or dislocations of the joints, which is very painful and this repeatedly happening will make the connective tissue even weaker. So gentle exercise is best. Like swimming.

However, it turns out that swimming is not all that great for asthma.

Even though swimming as a training modality has definite benefits for the patient with asthma. These include an increase in aerobic fitness and a decrease in asthma morbidity. There is no conclusive evidence, however, that swim training causes a decrease in the severity or frequency of exercise-induced bronchoconstriction.

Swimming poses two potentially deleterious effects to the patient with asthma.

– One is the exaggerated parasympathetic tone due to the ‘diving reflex’, that has been shown to trigger bronchoconstriction.

– The other is airway irritation because of chlorine and its derivatives. *

It’s all a bit of a challenge.

*source: https://pubmed.ncbi.nlm.nih.gov/1470792/