Exercise-Induced Asthma

Like it sounds, exercise-induced asthma is asthma that is triggered by vigorous or prolonged exercise or physical exertion. Most people with chronic asthma experience symptoms of asthma during exercise. However, there are many people without chronic asthma who develop symptoms only during exercise.

During normal breathing, the air we take in is first warmed and moistened by the nasal passages. Because people tend to breathe through their mouths when they exercise, they are inhaling colder and drier air.

In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity and react by contracting, which narrows the airway. This results in symptoms of exercised-induced asthma, which include:

• Coughing with asthma



• Tightening of the chest



• Wheezing



• Unusual fatigue while exercising



• Shortness of breath when exercising

The symptoms of exercise-induced asthma generally begin within 5-20 minutes after the start of exercise, or 5-10 minutes after brief exercise has stopped. If you are experiencing any of these symptoms with exercise, inform your doctor.

No. You shouldn't avoid physical activity because of exercise-induced asthma. There are steps you can take for prevention of asthma symptoms that will allow you to maintain normal physical activity. In fact, many athletes -- even Olympic athletes -- compete with asthma. For example, in the 1996 Olympic Games, 1 out of every 6 athletes had asthma. These Olympians competed in a variety of sports such as track and field, mountain biking, kayaking, cycling, and rowing. The following is an abbreviated list of athletes who have competed despite their asthma.

• Jackie Joyner-Kersee - track and field



• Jerome Bettis - NFL running back



• Amy Van Dyken - swimming



• Dennis Rodman - NBA basketball



• Ray Bourque - NHL hockey

Yes. Asthma inhalers or bronchodilators used prior to exercise can control and prevent exercise-induced asthma symptoms. The preferred asthma medications are short-acting beta-2 agonists such as albuterol. Taken 15-20 minutes before exercise, these medications can prevent the airways from contracting and control exercise-induced asthma for as long as 4-6 hours.

Other asthma treatments that may be useful are the long-acting beta-2 agonists, such as Serevent and Foradil, which provide 12-hour control. When these medications are taken in the morning, exercise-induced asthma symptoms may be avoided with any exercise throughout the day. It is important, however, to always have an asthma inhaler available in case symptoms still occur.

In addition to taking medications, warming up prior to exercising and cooling down after exercise can help in asthma prevention. For those with allergies and asthma, exercise should be limited during high pollen days or when temperatures are extremely low and air pollution levels are high. Infections can cause asthma (colds, flu, sinusitis) and increase asthma symptoms, so it's best to restrict your exercise when you're sick.

For people with exercise-induced asthma, some activities are better than others. Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, walking, and wrestling, are generally well tolerated by people with exercise-induced asthma.

Activities that involve long periods of exertion, like soccer, distance running, basketball, and field hockey, may be less well tolerated, as are cold weather sports like ice hockey, cross-country skiing, and ice skating. However, many people with asthma are able to fully participate in these activities.

Swimming, which is a strong endurance sport, is generally well tolerated by asthmatics because it is usually performed in a warm, moist air environment.

Maintaining an active lifestyle, even exercising with asthma, is important for both physical and mental health. You should be able to actively participate in sports and activities.

• Always use your pre-exercise inhaled medicines before beginning exercise.



• Perform warm-up exercises and maintain an appropriate cool down period after exercise.



• If the weather is cold, exercise indoors or wear a mask or scarf over your nose and mouth.



• Avoid exercising outdoors when pollen counts are high (if you have allergies), and also avoid exercising outdoors when there is high air pollution.



• Restrict exercise when you have a viral infection.



• Exercise at a level that is appropriate for you.

Again, asthma should not be used as an excuse to avoid exercise. With proper diagnosis and treatment of asthma, you should be able to enjoy the benefits of an exercise program without experiencing asthma symptoms.

SOURCES: American Academy of Allergy Asthma & Immunology: "Allergic Conditions: Exercise-Induced Asthma (EIA)." American Lung Association: "Search LungUSA."

Reviewed by Jonathan L. Gelfand, MD, on July 20, 2008

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