Mahendra P. Dadhania, MD Shailen R. Shah, MD
Adele M. Guernica, DO
Board Certified by American Board of Allergy & Immunology
Office locations in South Jersey, NJ Shore and Montgomery County in Pennsylvania
Excercise Induced Asthma
Tips to Remember: Exercise-Induced Asthma
Do you experience coughing, wheezing, or chest tightness when you
exercise? Do you feel extremely tired or short of breath when you exert
yourself? If you have these symptoms, you may be one of many people with
exercise-induced asthma (EIA). Approximately 7% of the population, or about
18 million Americans, are reported to suffer from asthma. With strenuous
physical exercise, most of these individuals experience asthma symptoms. In
addition, many non-asthmatic patients - up to 13% of the population, up to
40% of patients with allergic rhinitis and often people who have a family
history of allergy - experience asthma associated with exercise.
Symptoms and triggers
If you have exercise-induced asthma, you may experience breathing difficulty
within 5-20 minutes after exercise. Symptoms may include wheezing, chest
tightness, coughing and chest pain. Other EIA symptoms include prolonged
shortness of breath, often beginning 5-10 minutes after brief exercise.
Patients with EIA have airways that are overly sensitive to sudden
changes in temperature and humidity, especially when breathing colder, drier
air. During strenuous activity, people tend to breathe through their mouths,
allowing the cold, dry air to reach the lower airways without passing
through the warming, humidifying effect of the nose. With mouth breathing -
also common in patients with colds, sinusitis and allergic rhinitis ("hay
fever") - air is moistened to only 60-70% relative humidity, while
nose-breathing warms and saturates air to about 80 to 90% humidity before it
reaches the lungs.
In addition to mouth-breathing, air pollutants, high pollen counts, and
viral respiratory tract infections can also increase the severity of
wheezing with exercise.
To confirm a diagnosis of EIA, a physician:
- Obtains a patient history.
- Performs a breathing test when the patient is at rest to ensure that
the patient does not have chronic asthma.
- Often may perform a breathing test after exercise.
Measurement can be done in a medical facility or "on the field." In the
office setting, a patient exercises for six to eight minutes using a
treadmill or cycle to create enough exertion to maintain a heart rate at
80-90% of the age-related maximal predicted value. The patient breathes into
a breathing machine called a spirometer, which processes the patient's
ability to breathe out, or expire air. This test is performed before
exercise and at various intervals from two to 30 minutes after exercise
stops. A decrease of at least 12-15% in the volume of air blown out (as
compared to the starting value) by the patient in one second (termed the
forced expiratory value in one second, or FEV 1) indicates possible EIA.
On the field, expiratory airflow can be evaluated before and after a six-
to eight-minute "free run" or after participation in a sport or activity
that usually induces respiratory symptoms. Airflow is again measured for 30
minutes after exercise ends. Although a portable spirometer can be used,
physicians often recommend a small, relatively inexpensive peak flow meter
to demonstrate the characteristic post-exercise decrease in expiratory
airflow. In this case a 15-20% decrease is required for the test to be
considered positive for EIA.
Although the type and duration of recommended activity varies with each
individual, some activities are better for those with EIA. Swimming is often
considered the sport of choice for asthmatics and those with a tendency
toward bronchospasm because of its many positive factors: a warm, humid
atmosphere, year-round availability, toning of upper body muscles, and the
way the horizontal position may help mobilize mucus from the bottom of the
lungs. Walking, leisure biking, hiking and free downhill skiing are also
activities less likely to trigger EIA. In cold weather, wearing a scarf or
surgical mask over the mouth and nose can decrease symptoms by warming
Team sports that require short bursts of energy, such as baseball,
football, wrestling, golfing, gymnastics, short-term track and field events
or surfing are less likely to trigger asthma than sports requiring
continuous activity such as soccer, basketball, field hockey or
long-distance running. Cold weather activities such as cross-country skiing
and ice hockey are also more likely to aggravate airways. However, many
asthmatics have found that with proper training and medical treatment, they
are able to excel as runners or even basketball players.
Inhaled medications taken prior to exercise are helpful in controlling and
preventing exercise-induced bronchospasm. The medication of choice in
preventing EIA symptoms is a short-acting beta2agonist
bronchodilator spray used 15 minutes before exercise. These medications,
which include albuterol, pirbuterol, and terbutaline, are effective in 80 to
90% of patients, have a rapid onset of action, and last for up to four to
six hours. These drugs can also be used to relieve symptoms associated with
EIA after they occur.
In the school setting, these medications may be administered to children
by school nurses. A long-acting bronchodilator spray that lasts up to 12
hours is also available. By using this before school, many children are able
to participate in gym class and other sports throughout the day without
needing short-acting sprays.
If symptoms are not readily controlled by medications, patients should
talk to their physician about using daily medication that treats the
underlying asthma-the inflammatory process that is causing increased
"twitchiness" or sensitivity of the airways. In addition to medications, a
warm-up period of activity before exercise may lessen the chest tightness
that occurs after exertion. A warm-down period, including stretching and
jogging after strenuous activity, may prevent air in the lungs from changing
rapidly from cold to warm, and may prevent EIA symptoms that occur after
Athletes should restrict exercising when they have viral infections, when
temperatures are extremely low, or - if they are allergic - when pollen and
air pollution levels are high. Pursed (narrowed) lip breathing may also help
reduce airway obstruction.
Asthma and the Olympics
According to a recent study, at least one in six athletes representing the
United States in the 1996 Olympic Games had a history of asthma. Although
4-7% of the general population is reported to have asthma, the number of
Olympic athletes who reported asthma was considerably higher. Out of 699
athletes, 117 (16.7%) were found to have a history of asthma, or to have
used asthma medications, or both. Seventy-three (10.4%) of the athletes had
active asthma, based on their need for asthma medication at the time of the
games, or their need for medication on a permanent or semi-permanent basis.
Among the Olympic athletes, asthma was most common among cyclists and
mountain bikers and least common in athletes competing in badminton, beach
volleyball, table tennis and volleyball. Interestingly, nearly 30% of the
1996 U.S. Olympians who had asthma or took asthma medications won team or
individual medals in their Olympic competition, faring as well as athletes
without asthma (28.7%) who earned team or individual medals.
Exercise is beneficial to both physical health and emotional well-being.
Even if they are not striving for an Olympic medal, almost all people with
EIA should be able to exercise to their full ability with appropriate
diagnosis and treatment.
Your allergist/immunologist can provide you with more information on
Tips to Remember are created by the Public Education Committee
of the American Academy of Allergy, Asthma and Immunology. This brochure was
updated in 2003.
The content of this brochure is for informational purposes only. It is
not intended to replace evaluation by a physician. If you have questions or
medical concerns, please contact your allergist/immunologist.
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