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Living with exercise-induced asthma

By Louis Neipris, M.D., Staff Writer, myOptumHealth

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Whether you exercise for fun and fitness or compete professionally, exercise-induced asthma doesn’t have to be an obstacle. You can often still run, bike, row or do whatever you like to stay active. You can usually even compete, as long as you get your asthma formally diagnosed and under good control. You can find inspiration in the many Olympic athletes who use an asthma inhaler. Your doctor can help you find the right meds, teach you to monitor your symptoms and encourage you to stay on the track while avoiding the hurdles.

What is exercise-induced asthma?

Exercise-induced asthma is asthma symptoms that occur within 20 minutes of starting to exercise. It is also called exercise-induced bronchospasm. Some people get symptoms shortly after they stop the exercise. Some people with exercise-induced asthma don’t have asthma symptoms any other time. For others, exercise is one of several things that trigger asthma symptoms. Symptoms can include:

  • Wheezing
  • Chest tightness
  • Cough
  • Shortness of breath

In exercise-induced asthma, the main bronchi (air passages) through which air passes in and out of the lungs become inflamed. Muscles surrounding the bronchi tighten and cells produce extra mucous. When not exercising, you usually breathe through your nose, where air is warmed and humidified before reaching the lungs. When you exercise, you tend to breathe more quickly through your mouth, making the air cooler and drier. Cool, dry air can trigger asthma symptoms in some people.

How is it diagnosed?

Your doctor will ask about your symptoms and how they relate to exercise. He or she will make sure your symptoms are not caused by heart disease or other conditions. The doctor will want to know what kind of exercise or exertion causes symptoms. You may have:

  • Lung function tests, which measure how well your lungs work at rest.
  • An exercise challenge test, which measures lung function after exercise. In the doctor’s office you run on a treadmill, ride an exercise bike or do some other sort of physical activity for a few minutes to see if you develop asthma symptoms. You may be given an inhaler medication to see if your symptoms improve. Reversible symptoms are a good indicator of asthma.

How is it treated?

1) Pretreatment therapy

You can often prevent symptoms by treating with an inhaler 15 minutes or more prior to exercise. Examples of pretreatment inhaled medications include:

  • A fast acting bronchodilator. You take the inhaler, such as albuterol (Proventil HFA, Ventolin HFA) at least 15 minutes before exercise to prevent symptoms for about two to three hours.
  • A mast-cell stabilizer (such as cromolyn sodium or nedocromil sodium) in inhaler form that you take 15 minutes or more before exercise. Some can be taken up to an hour before exercise.

Ask your doctor about how and when to use the specific medicine that you have been prescribed.

2) Long-term control therapy

If you have frequent or severe exercise-induced asthma attacks, your doctor may decide to start you on medication to treat the underlying inflammation that causes asthma. This is usually an inhaled corticosteroid such as fluticasone (Flovent HFA) or budesonide (Pulmicort).

What else do I need to know about exercise-induced asthma?

Even with exercise-induced asthma, you can usually exercise. The goal is to keep your symptoms under control when you exercise or take part in the sport of choice. Activity choices that tend to be compatible with exercise-induced asthma include:

  • Sports where you can take a break, such as baseball or golf.
  • Swimming, because you are exposed to warm, moist air that does not usually trigger asthma symptoms. The smell of chlorine, though, can be irritating to some people.

Winter sports and cold-weather exercise can be great for people who are allergic to pollens and molds, but cold weather itself can bring on asthma symptoms. If you have this reaction to cold weather, wearing a scarf across your nose and mouth can help warm the air you breathe.

No matter what the environmental conditions, plan to spend 10 to 15 minutes warming up before exercise and 10 to 15 minutes cooling down afterwards. Warming up lowers the likelihood that exercise will bring on asthma symptoms. You may also need to avoid exercise if you have a respiratory infection (such as cold or flu).

Before you start any exercise program, it’s very important that you talk to your doctor and, afterwards, that you stick to your doctor’s advice.

View the original Exercise-induced asthma article on myOptumHealth.com 

SOURCES:

  • National Jewish Health. Exercise-induced asthma. Accessed: 09/29/2009
  • McFadden ER Jr. Approach to the patient with exercise-induced airway narrowing. In: Adkinson NF, Bochner BS, Busse WW, Holgate ST, Lemanske Jr RF, eds. Adkinson: Middleton’s Allergy: Principles and Practice, 7th edition, Philadelphia, PA: Mosby Elsevier; 2008.
  • American Academy of Allergy, Asthma and Immunology. Tips to remember: asthma and exercise. Accessed: 09/29/2009
  • National Heart Lung, Blood Institute. Expert panel report 3 (epr3): guidelines for the diagnosis and management of asthma. Exercise-induced bronchospasm. Accessed: 09/29/2009