Asthma Facts and Instructions from the Asthma and Allergy Foundation of America

Exercise and Asthma

What is Exercise-Induced Asthma?

Exercise is a common cause of asthma symptoms. This is usually called exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB). It is estimated that 80 to 90 percent of all individuals who have allergic asthma will experience symptoms of EIA with vigorous exercise or activity. For teenagers and young adults this is often the most common cause of asthma symptoms. Fortunately with better medications, monitoring, and management you can participate in physical activity and sports and achieve your highest performance level.

What are the Symptoms of EIA?

Symptoms of exercised-induced asthma include coughing, wheezing, chest tightness and shortness of breath. Coughing is the most common symptom of EIA and may be the only symptom you have. The symptoms of EIA may begin during exercise and will usually be worse 5 to 10 minutes after stopping exercise. Symptoms most often resolve in another 20 to 30 minutes and can range from mild to severe. Occasionally some individuals will experience "late phase" symptoms four to twelve hours after stopping exercise. Late-phase symptoms are frequently less severe and can take up to 24 hours to do away.

What causes EIA?

When you exercise you breathe faster due to the increased oxygen demands of your body. Usually during exercise you inhale through your mouth, causing the air to be dryer and cooler than when you breathe through your nasal passages. This decrease in warmth and humidity are both causes of bronchospasm. Exercise that exposes you to cold air such as skiing or ice hockey is therefore more likely to cause symptoms than exercise involving warm and humid air such as swimming. Pollution levels, high pollen counts and exposure to other irritants such as smoke and strong fumes can also make EIA symptoms worse. A recent cold or asthma episode can cause you to have more difficulty exercising.

How is EIA Diagnosed?

It is important to know the difference between being out of condition and having exercise-induced asthma. A well-conditioned person will usually only experience the symptoms of EIA with vigorous activity or exercise. To make a diagnosis, your doctor will take a thorough history and may perform a series of test. During these tests, which may include running or a treadmill test, your doctor will measure your lung functions using a spirometer before, during and after exercise. Monitoring your peak flows before, during and after exercise can also help you and your doctor detect narrowing of your airways. Then, using guidelines established by your doctor you can help prevent asthma symptoms, participate in and enjoy physical activity. Your doctor will also tell you what to do should a full-blown episode occur.

Treatment and Management of EIA

With proper treatment and management people with EIA can participate safely and achieve their full potential. Proper management requires that you take steps to prevent symptoms and carefully monitor your respiratory status before, during and after exercise. Taking medication prior to exercising is important in preventing EIA. Proper warm up for 6 to 10 minutes before periods of exercise or vigorous activity will usually help. Individuals who can tolerate continuous exercise with minimal symptoms may find that proper warm up may prevent the need for repeated medications.

What Types of Medications Treat/Prevent EIA?

There are three types of medications to prevent or treat the symptoms of EIA. Your health care provider can help you determine the best treatment program for you based on your asthma condition and the type of activity or exercise.

The first medication is a short-acting beta2-agonist, also called a bronchodilator. This medication can prevent symptoms and should be taken 10 to 15 minutes before exercise. It will help prevent symptoms for up to four hours. This same medication can also be used to treat and reverse the symptoms of EIA should they occur.

The second medication is a long-acting bronchodilator. Currently there is only one type of this medication available. It is salmeterol. It needs to be taken 30 to 60 minutes prior to activity and only once within a 12-hour period. Salmeterol can help prevent EIA symptoms for 10 to 12 hours. This medication should only be used to prevent symptoms and should never be used to relieve symptoms once they occur because it does not offer any quick relief.

The third type of medication is cromolyn or nedocromil. They also need to be taken 15 to 20 minutes prior to exercise. There is also some evidence that taking these medications will also help to prevent the late phase reaction of EIA that is experienced by some individuals. These medications also should only be used as a preventative measure because they do not relieve symptoms once they begin. Some individuals use one of these medications in combination with a short-acting bronchodilator.

If you have frequent symptoms with usual activity or exercise, talk to your doctor. An increase in your long-term control medications may help. Long term antiinflammatory medications such as inhaled steroids, can reduce the frequency and severity of EIA.

Teachers and coaches should be informed if a child has exercise-induced asthma. They should be told that the child should be able to participate in activities, but that they may require medication prior to activity. Athletes should also disclose their medications and adhere to standards set by the U.S. Olympic Committee. Approved and prohibited medications can be obtained from the committee hotline (800-233-0393).

What Types of Sports are Best for People with EIA?

Activities that involve only short burst of exercise or intermittent periods of activity are usually better tolerated. Such sports include walking, volleyball, gymnastics or baseball. Swimming that involves breathing warm and moist air, is often well tolerated. Aerobic sports such as distance running, soccer or basketball are more likely to cause symptoms. In addition cold air sports such as ice hockey or ice-skating may not be
tolerated as well.

It is important to consult with your health care provider prior to beginning any exercise program and to pace yourself. With effective management people with EIA can perform and excel in a variety of sports. Many Olympic athletes and professional athletes with exercise-induced asthma have excelled in their sports, many winning Olympic gold medals.

Remember, with proper medical management you should be able to walk, climb stairs, run, and participate in activities, sports and exercise without experiencing symptoms. Do not let EIA keep you from leading an active life or from achieving your athletic dreams.

This information should not substitute for seeking responsible, professional medical care.

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