Exercise and Asthma: A Dangerous Mix?

Last Editorial Review: 1/30/2005

Controlling Asthma

By Alison Palkhivala
WebMD Feature

Reviewed By Gary Vogin

Oct. 22, 2001 -- The sports world was shaken when football player Rashidi Wheeler died suddenly of an asthma attack during a training session in July. Can exercise typically cause such severe, life-threatening asthma symptoms? How can asthma sufferers protect themselves or parents protect their asthmatic children? Read on to find out.

What Is Asthma?

Asthma is a chronic lung condition in which the airways of the lungs are extra sensitive. Whenever they are irritated from the outside, such as by pollens or pollution in the air, or from the inside, such as by eating food you are allergic to, they respond by tightening up, making it difficult to breathe. Symptoms of asthma include coughing, wheezing, shortness of breath, and a feeling of tightness or even pain around the chest. In very severe cases, the airways can close up completely, making breathing impossible.

Though deaths from asthma do occur, they are mercifully rare. According to expert Elliott Pearl, MD, only about 4,000 people a year die from asthma in the U.S., which sounds like a lot until you take into account that 15 million people in the U.S. suffer from the condition. Most of the people who die of the disease do not have it under good control with available medication. Pearl is an allergist and immunologist at ENTAAcare, a collection of ear, nose, throat, allergy, and asthma specialists working in the Annapolis-Baltimore, Md., area.

Asthma is treated with two types of medication. Short-acting "rescue" medication, usually in the form of an inhaler or bronchodilator containing a drug that opens the airways, can be taken to stop an episode of asthma in its tracks. Longer-acting "maintenance" medications, such as pills or inhalers that have an anti-inflammatory action, are taken every day to prevent an attack from occurring.

Asthma and Exercise

For some people, asthma is brought on only by exercise. For others, exercise is only one of many factors, including cold, dry air, allergens in the air, or pollution, which bring on asthma symptoms.

"Most people with asthma have some degree of what we call post-exercise bronchospasm, " Norman H. Edelman, MD, tells WebMD. "Usually when they're exercising, they're OK, but when they stop, their airways tighten up. ... This has to do with the fact that when you exercise a lot, you breathe very fast, you dry out some of the airways, and that's a trigger for tightening of the airways. If they do it in very cold weather, it's much worse because cold air is more drying than warm air." Edelman is a consultant for scientific affairs to the American Lung Association as well as dean of the School of Medicine and vice president of the University Medical Center at the State University of New York at Stony Brook.

No matter what triggers your asthma, experts agree that all but those with the most severe asthma should be able to participate in sports and exercise. In fact, Pearl says that people with asthma are less likely to have trouble if they are in good condition. The worse shape you're in, the more you need to breathe to perform an activity, and the easier it is for your airways to dry out.

Jerome "The Bus" Bettis, a 29-year-old player with the Pittsburgh Steelers, was diagnosed with asthma at age 14, but he doesn't let it stop him from following his dream.

The experts agree that most people with asthma can exercise safely if they follow a few basic commonsense tips:

Don't participate in sports unless your asthma is well controlled (with or without daily medication). That means that you're not having a lot of symptoms when you're not exercising.

  • Take a couple of puffs of a bronchodilator about 15 minutes before you exercise. This should prevent an asthma attack during exercise in most people.
  • If you start to feel symptoms of your asthma coming on, stop your activity and use your bronchodilators again. If you don't start feeling better soon after you take your medication again, it might be time to seek emergency care.
  • Do not exercise in conditions that you know make your asthma worse. For instance, don't exercise outside during ragweed season if you are allergic to ragweed.
  • Drink plenty of water to help prevent your airways from drying out.
  • Don't exercise if you have a respiratory tract infection like a cold or flu.
  • Don't exercise outside on hot, dry days.
  • Know that sudden, severe asthma attacks are rare but can occur even in people with mild asthma. They require emergency care. A sudden attack like this might be what killed Wheeler.

Bettis tells WebMD that for him, "the biggest thing [in controlling my asthma during exercise] is to monitor my heart rate and not let it start to soar. Periodically during my workout I need to take breaks and monitor myself. ... When my lungs dry up, it gets a little bit difficult for me, so I take a lot of water breaks. " He says he became motivated to learn more about his asthma when he had an attack in the middle of a game in 1997.

For some people with very severe asthma, certain intense sports, particularly those that require a lot of running, may not be a good idea. One of the best types of exercise for severe asthma sufferers is swimming, since it still gives you a good cardiovascular workout and the warm, humid environment reduces the risk of having an asthma attack.

Whether you're exercising or not, people with moderate to severe asthma should talk to their doctors about developing an action plan. This is a written description of what to do about every sign and symptom of an asthma attack, including when to seek emergency help. Some asthma suffers carry around a device called a peak flow meter. It measures how well you can breathe out and is a good indicator of how bad an asthma attack is.

Children and Asthma

Stuart Abramson, MD, PhD, is an assistant professor of pediatrics and immunology at Baylor College of Medicine and associate director of the Children's Asthma Center at Texas Children's Hospital in Houston. He says that asthma in children should be managed in a similar way to that of adults.

Kids with asthma should be encouraged to enjoy physical activity as long as their asthma is well controlled and conditions are good. Their parents, coaches, teachers, and school nurses should have a written copy of their asthma action plan as well as bronchodilators handy. The children themselves should carry a bronchodilator with them everywhere. Children with asthma need to learn their limits and know when to stop an activity and take a puff of medicine.

The Alternative Approach

Asthma is caused by an inflammation of the lungs, and Jerome Greenberg, DC, a chiropractor and clinical nutritionist in Manhattan, says that most conditions caused by an excess of inflammation, like asthma, arthritis, and diabetes, are made worse by improper diet. He says that eating healthy, natural oils like fish liver oils, which contain omega-3 fatty acids, and avoiding unhealthy oils, particularly the hydrogenated oils found in many baked, fried, and prepared foods on supermarket shelves, should help inflammation considerably.

Greenberg, who is former president of the Chiropractic Federation of New York, former director of the New York State Chiropractic Association and current director of New Millennium Medical Services in New York, also says that drinking plenty of water is also very helpful for asthma.

Advice From The Bus

In the end, Bettis gives the best advice. He says no one should feel embarrassed at having asthma or let it stop them from reaching their goals. "Understand and know what asthma is, " he says. "Because of the [airway] inflammation process, it's important for you to be on a daily [medicine] routine. Develop a game plan with your doctor so that you are able to effectively manage the disease, and it doesn't manage you. "

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