Your Body: Deep Breaths

January 24, 2010

The pace of Swan Lake’s Act II can be trying for any ballerina, but for Ballet Austin’s Rebecca Johnson, it can be a heavy breathing experience. Johnson has exercise-induced asthma, a condition she needs to manage so that it does not get in the way of her dancing. “I keep my inhaler close by during Swan,” says Johnson, 25 and in her fourth season with the company. “I have to be vigilant.”


More than 31 million people in the U.S. suffer from asthma, a chronic inflammation or constriction of the bronchial tubes. Boston Ballet physician Bridget Quinn, MD, has treated many a dancing asthmatic. “There’s no reason why a person with mild to moderate asthma can’t enjoy a career as a professional dancer,” says Quinn, a sports medicine physician at Children’s Hospital Boston. “Dancing could even help. Research has shown that exercise improves respiratory physiology and an individual’s perception of their shortness of breath.” Understanding the kind of asthma you have, what triggers it, and the right ways to medicate your symptoms are key to dancing with it.


There are several types of asthma, with exercise-induced and allergic asthma the most common. Exercise-induced asthma is triggered by physical activity, while allergic asthma is brought on by exposure to various allergens such as pollen, mold, dust mites, or pet dander. Symptoms can range from coughing to wheezing to occasional episodes of shortness of breath. There is no permanent cure, but asthma can be successfully managed with medication. “Know your triggers and minimize them as best you can,” says Quinn. “Sometimes I suggest keeping a trigger diary.” Triggers can be everywhere, from the dust mites on Nutcracker snow to your neighbor’s cat.


Weather can be another factor. Bradley Schlagheck, who has danced for BalletX and Boston Ballet, suffers from both exercise-induced and allergic asthma. He was diagnosed at age 7, about the same time he started dancing. “The cold usually makes it harder for me to breath,” says Schlagheck.


Treatment involves a two-pronged approach. Long-term medicines such as inhaled corticosteroids (ICS), powerful anti-inflammatories, prevent symptoms from occurring in the first place. Quick-relief asthma medications, such as short-acting beta2-agonists, immediately prevent tightening of the muscles around the airways. These also can make a dancer feel anxious and shaky, since they speed up your metabolism as well. “They can make your heart race,” says Quinn. She suggests using the inhaler 30 minutes before performing. Johnson says she gets a bit jittery when using her inhaler during a show, but so far it’s not gotten in the way of her performances.


It took a while for both Johnson and  Schlagheck to get the right combination of medication. “I’m just using my fast-acting inhaler now,” Schlagheck says. Johnson uses a combination of anti-inflammatory medication and an inhaler, which she keeps with her at all times. “I just think about it like an extra pair of pointe shoes,” she says.


Attitude and anxiety also play a role. Schlagheck pulled through a Boston Ballet performance of Twyla Tharp’s relentlessly paced In the Upper Room by paying attention to places to breathe in the choreography. “I have also learned not to freak out. It can be scary when your airways close down,” says Schlagheck. “If I feel trouble coming on, I place my arms over my head, which opens my chest.”


Schlagheck just finished BalletX’s strenuous season, which included works by Matthew Neenan, Alex Ketley, and Meredith Rainey. “There were still times when I was out of breath, but I got through it without my inhaler,” he says. “Asthma is not going to stop me.”


Quinn recommends yoga, which creates a deep awareness of breathing, and the Buteyko Method, which offers exercises that improve your breathing chemistry so that more oxygen arrives at your cells, keeping airways open.


Only in very bad cases would Quinn suggest a dancer select another career. “If your asthma is so severe that you need anabolic steroids, it might be time to consider other options, as those could have long term effects on your bone health,” she says. “High doses could put a dancer at risk of stress fractures.”


Johnson considers her condition something she needs to keep on top of, not unlike her technique. “We all have limitations, I just happen to have this one,” she says. “I can’t forget I have it or ignore it,” says Johnson. “Nor do I make it an excuse or let it own me. I have learned to take control.”



Nancy Wozny writes about the arts and health from Houston.


Pictured: Bolshoi Ballet dancers in the wings at the Maryinsky Theatre. Photo by Rachel Papo.