Exercise-Induced Bronchoconstriction (Asthma)

Everyone needs to exercise, even people with asthma! A strong, healthy body is one of your best defenses against disease. But some people with asthma have asthma episodes during exercise. With proper prevention and management, you should be able to exercise free of symptoms.

What Is Exercise-Induced Asthma?

Exercise can cause shortness of breath in anyone. Airflow obstruction that occurs because of exercise is exercise-induced bronchoconstriction (EIB). An older term for this condition is exercise-induced asthma. This term wrongly suggests that exercise causes asthma. As many as 90% of all people who have asthma will experience symptoms of EIB during exercise. For teenagers and young adults, this may be the most common cause of asthma symptoms.

What Are the Symptoms of EIB?

Symptoms of EIB include:

• Coughing
• Wheezing
• Chest tightness
• Shortness of breath

Coughing is the most common symptom of EIB and may be the only symptom you have.

Symptoms usually do not occur immediately at the start of exercise. The symptoms of EIB 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 a second wave (i.e. “late-phase”) of symptoms four to twelve hours after stopping exercise. Late-phase symptoms are frequently less severe and can take up to 24 hours to resolve.

What Causes EIB?

When you exercise, you breathe faster and deeper due to the increased oxygen demands of your body. You usually inhale through your mouth, causing the air to be dryer and cooler than when you breathe through your nose. The dry and/or cold air is the main trigger for airway narrowing (bronchoconstriction). Exercise that exposes you to cold, dry air is more likely to cause asthma symptoms than exercise involving warm and humid air. Other triggers that can make EIB symptoms worse:

• Pollution levels
• High pollen counts
• Exposure to other irritants, such as smoke and strong fumes
• A recent cold or asthma episode

How Do Doctors Diagnose EIB?

It is important to know the difference between being out of condition and having EIB. To make a diagnosis, your doctor will take a thorough history and may perform a series of tests. Your doctor will measure your breathing before, during and after exercise to test your lung functions. Then, your doctor will help you create a plan so you can take steps to prevent asthma symptoms and enjoy physical activity. Your doctor will also tell you what to do should a full-blown asthma episode occur.

How Can I Manage and Treat My EIB?

With proper management, you can enjoy exercise and achieve your full potential. Proper management requires that you:

• Take steps to prevent symptoms (e.g. cover your mouth/nose with a scarf if exercising in cold, dry weather)
• Take medicine before exercising
• Do a proper warm up for 6 to 10 minutes before periods of exercise or vigorous activity
• Carefully watch your respiratory status before, during and after exercise

Children With EIB
Inform teachers and coaches if you have a child with EIB. Kids with EIB should be able to take part in activities; they just may need medication before an activity.

Athletes With EIB
If you are an athlete, disclose your medicines and adhere to standards set by the U.S. Olympic Committee. Request a list of approved and prohibited medications from the Committee hotline at 1-800-233-0393.

What Types of Sports Are Best for People with EIB?

Activities most likely to trigger EIB:

• Sports or activities in cold/dry weather (ice hockey, skiing, ice skating, snowboarding)
• Sports or activities that need constant activity (long distance running, soccer)

Activities least likely to trigger EIB:

• Sports or activities that use short bursts of exercise (volleyball, baseball, gymnastics)
• Walking or leisure biking
• Swimming in a warm, humid environment

It is important to consult with your health care provider before beginning any exercise program. Pace yourself. With effective management, people with EIB can perform and excel in a variety of sports. Many Olympic athletes and professional athletes with EIB excel in their sports.

How Can You Prevent Asthma Attacks During Exercise?

Dr. Neeta Ogden, Rashad Jennings and a team of kids with asthma share the steps you can take to manage your asthma before, during and after exercise:

What Types of Medicines Treat or Prevent EIB?

There are three types of medicines to prevent or treat the symptoms of EIB. Your health care provider can help you find the best treatment program for you based on your asthma history and the type of activity.

• Short-acting beta agonist / bronchodilator (“bron-co-die-a-lat-er”):
  This medication can prevent symptoms when taken 10 to 15 minutes before exercise. It will help prevent symptoms for up to four hours. This same medication can also treat and reverse the symptoms of EIB should they occur.
• Long-acting bronchodilator:
  This needs to be taken 30 to 60 minutes before activity and only once within a 12-hour period. Salmeterol can help prevent EIB symptoms for 10 to 12 hours. This medication is for preventing symptoms. It does not offer any quick relief, so it not for treating symptoms once they begin.
• Mast cell stabilizers:
  Cromolyn sodium or nedocromil sodium need to be taken 15 to 20 minutes before exercise. These medications may also help to prevent the late phase reaction of EIB that some people experience. These medications are only for preventing EIB because they do not relieve symptoms once they begin. Some individuals use one of these medicines 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 control medicines, such as inhaled steroids, can help EIB.

Remember, you should be able to take part in activities, sports and exercise without experiencing symptoms! Do not let EIB keep you from leading an active life or from achieving your athletic dreams.

Medical Review October 2015.