Exercise-induced asthma

Exercise-induced asthma needs no category of its own. If you have asthma symptoms when you exercise, you have asthma — it's that simple. Avoid exercise-induced asthma symptoms by using an inhaler before strenuous activity.

Do you regularly cough and feel short of breath about five to 10 minutes into a good, heart-pumping workout? If so, you may have asthma. Your breathing problems during exercise are part of the underlying condition. Exercise-induced asthma is asthma that is triggered by vigorous or prolonged exercise or physical exertion. Most people with chronic asthma experience symptoms with exercise. However, there are many people without chronic asthma who develop symptoms only during exercise.

People with mild exercise-induced asthma may not realize that their symptoms go beyond the body's normal response to exertion. They blame their difficulty on being out of shape or short on endurance. The good news is that when your asthma is properly recognized and treated, you'll probably be able to exercise as much as you want.

Asthma and exercise: Why Does Exercise Cause Asthma Attacks?

Many people with asthma have bouts of wheezing and breathlessness when they exercise strenuously. This reaction is known as exercise-induced asthma or exercise-induced bronchospasm (EIB).

Exercise-induced asthma is not a distinct type of asthma. Instead, it is likely to occur in anyone who has the airway reactivity that underlies asthma. Your airways — the passages branching off your windpipe to carry air to and from your lungs — are reactive if they tend to narrow under certain circumstances, such as after exposure to an allergen or while you are suffering from a cold. The linings of reactive airways are prone to inflammation and excess mucus secretion as well.

During normal breathing, the air we take in is first warmed and moistened by the nasal passages. Because people tend to breathe through their mouths when they exercise, they are inhaling colder and drier air.

In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity and react by contracting, which narrows the airway. This results in symptoms of exercised-induced asthma, which include:

• Coughing
• Tightening of the chest
• Wheezing
• Unusual fatigue while exercising
• Shortness of breath when exercising

The symptoms of exercise-induced asthma generally begin within 5-20 minutes after the start of exercise, or 5-10 minutes after brief exercise has stopped. If you are experiencing any of these symptoms with exercise, inform your doctor.

Exercise-induced asthma: Who's at risk?

Because they're more active than adults, children are more likely to wind up at the doctor's to find out why they have trouble catching their breath when they play hard. Exercise-induced symptoms are often the tip-off that a child has asthma. Other triggers may become apparent over time.

At all ages, though, physical activity is a common cause of acute airway constriction — in other words, of asthma attacks. Only colds are more likely to cause asthma symptoms. Aerobic exercise, such as running or playing basketball, hockey or soccer, is more likely to trigger asthma symptoms than is weightlifting, golfing or moderate-paced walking. Swimming is aerobic, but because humidity is higher near water, your airways are more likely to stay open.

Are regular asthma and exercise-induced asthma different conditions?

On a practical level, they're the same. About 90 percent of people with chronic asthma have exercise-induced asthma. And a subgroup of people with exercise-induced asthma — by some estimates, between 5 percent and 10 percent — have symptoms only when they exercise. Allergies, pet hair, respiratory infections — none of these common triggers causes asthma symptoms in this group.

Even so, exercise-induced symptoms are usually no different from those of asthma induced by other triggers. Typically, the symptoms appear during exercise, but they may not start until after. And asthma episodes related to exercise tend not to last as long as other asthma attacks.

If I Have Asthma, Should I Avoid Exercise?

No. You shouldn't avoid exercise because of exercise-induced asthma. There are steps you can take to control the symptoms and allow you to maintain normal physical activity.  Exercise is important for everyone. No one should be excused from regular exercise because of asthma. People with asthma are often afraid to exercise because they do not want to provoke symptoms. This lack of exercise causes worsening of your overall conditioning which decreases your tolerance for activity or exercise. What happens next is you get breathless with very little activity. This makes you even more afraid to exercise and you become inactive. Physical activity helps everyone feel better about themselves. People with asthma need the regular conditioning that comes with exercise to maintain their overall health.

Just the facts:

• The fitter you are, the better your lungs work.

• The better your lungs work, the fewer problems you should have with your asthma.

• The fewer problems you have with your asthma, the better you’ll feel and the more you’ll be able to do.

• There are lots of ways to get exercise. Find one that you like, and work with your doctor or asthma coordinator to keep asthma under control.

• Having an Asthma Action Plan takes all the mystery out of treating your asthma. Make sure your coaches have a copy, and know what to do if you need help.

Treating exercise-induced asthma

Because exercise-induced asthma has the same symptoms and results from the same airway reaction involved in regular asthma, standard asthma medications can control it. Depending on the severity and frequency of your symptoms, your doctor may prescribe:

• A short-acting inhaled bronchodilator, such as albuterol (Proventil, Ventolin) or pirbuterol (Maxair), used 15 minutes before exercise to prevent symptoms for about four hours.
• A mast cell stabilizer, such as cromolyn sodium (Intal) or nedocromil sodium (Tilade), used 15 to 60 minutes before exercise to prevent symptoms for about four hours.
• A longer acting bronchodilator, such as salmeterol (Serevent Diskus) and formoterol (Foradil), taken 30 minutes before exercise to relieve symptoms for up to 12 hours.
• A leukotriene modifier, such as montelukast sodium (Singulair) or zafirlukast (Accolate), for effects lasting up to 24 hours. These drugs are helpful in reducing airway inflammation when exercise-induced symptoms are a feature of chronic asthma.

If you wheeze whenever you exert yourself or if allergies and irritants also trigger your symptoms, your doctor may recommend that you use a corticosteroid inhaler such as triamcinolone (Azmacort) or fluticasone (Flovent) every day. These drugs reduce inflammation. In addition, you may need daily doses of a longer acting bronchodilator.

What are the best ways to deal with asthma and exercise?

 Try these tips:

• Start with a 15-minute warm-up to allow the lungs to adjust to the increased demand for oxygen.

• In cold weather, cover your mouth and nose with a scarf to help warm the air before it gets to the lungs.

• Avoid triggers that may cause or worsen your asthma (for example, don’t exercise outdoors when pollen counts are high if pollen is a for you).

• End with a 15-minute cool-down rather than stopping abruptly.

• Do your best to stay free of colds and other respiratory infections. Refrain from strenuous exercise when you have a cold.
• Choose a humid exercise environment such as a trail alongside a lake or stream or a gym with an indoor pool.
• If allergies contribute to your asthma, use allergy medication as directed by your doctor, and avoid exercising anywhere you might be exposed to allergens.
• Learn to breathe through your nose or through pursed lips as much as possible while exercising.
• Wear a face mask during exercise.

• Follow your doctor’s instructions about using medication before or after exercise.  If you’re on a team, be sure your coach has a copy of your Asthma Action Plan.

·         Be extra careful when:

o        You’ve got a cold or other viral infection

o        It’s pollen season, or a cold, dry day (if these are your triggers)

With these added problems, even gentle exercise could an asthma attack.

 If you feel mild asthma symptoms coming on during a workout, try continuing your activity. Your symptoms may remain mild. Otherwise, if your doctor has prescribed an inhaler with a short-acting bronchodilator, pause and inhale two puffs, even if you have pretreated. You should breathe more easily within a few minutes. If you don't, stop exercising. Recurrent exercise-induced symptoms not relieved by a short-acting bronchodilator may mean you need to change your medication.

Remember, long-term controller medicines like cromolyn (such as Intal) and corticosteriods (such as Azmacort) should not be taken during an asthma attack because they do not open the airways quickly. If you don’t know which inhaler is the right one to take for quick relief, ask your doctor, asthma counselor or pharmacist to tell you before you need it in a hurry.  

Asthma Action/Management Plans

Make sure you talk to your doctor or asthma coordinator about what to do before, during and after exercise to keep you from having asthma symptoms. Then follow the Asthma Action/Management Plan prescribed by your doctor. The following steps can help you and your doctor make a plan that works for you:

* Keep an activity diary in which you write down your activities and when you have asthma symptoms. It’s a good idea to write down the steps you took to get relief, too, so that you can show your doctor how the treatment plan is working.
* When you take your medication can be very important. Ask your doctor about the best times to take each of your medications in relation to your exercise schedule.
* When you are being active, pay attention to the kinds of exercises that feel best to you, and the amount of time you can do them without asthma symptoms. For example, can you get through a whole marching band or football practice? How far can you run comfortably? By telling the doctor about your limits and abilities, he may be able to help you increase them, or help you find new ways to be active.
* If you follow your Asthma Action Plan and still have trouble breathing while working out, tell your doctor. He or she should be able to tweak the plan to keep you breathing easy.

Which sport or activity is best for you?

If your asthma is under control, then you should be able to do pretty much anything you enjoy. On the other hand, there are a few things you should think about when choosing a sport or activity:

Season: Does your asthma get worse in different seasons? If it does you may want to think about what season your activity takes place in. For example, if pollen makes you wheeze, spring training for baseball may give you trouble. This doesn’t mean that you can’t play baseball. It means that you should talk to your doctor or asthma counselor to make sure your medications will keep you symptom-free while you play.

Time Outs: Sometimes people with asthma do better in activities with definite starts and stops. Some activities with built in “time outs” for rest include baseball, gymnastics and marching band. Sports like soccer don’t allow as much rest time, and this may make the sport hard if your asthma is severe. In these kinds of sports, think about playing a position that doesn’t require quite so much running, and you can still be involved and have fun.

The big picture: An activity may seem like a good fit for you in some ways, but there may be other reasons not to choose it. For example, swimming is frequently a great choice because the added moisture in the air at the pool soothes inflamed lungs. On the other hand, some people have asthma that is triggered by chlorine. So look at the whole environment of the activity before you make your choice.

Who says you can’t be great?

• At the 1996 Olympic Games, at least one in six athletes from the U.S. had a history of asthma, had taken asthma medications or had symptoms that suggested asthma.  In fact, the athletes with asthma won just as many team or individual medals as their peers without asthma.

• Did you know that some famous athletes have asthma?  These athletes have learned to control their symptoms, and perform at the top level of their sport.
   

  • Jerome Bettis - professional football player
  • Bruce Davidson - Olympic equestrian
  • Tom Dolan, Olympic medalist - swimming
  • Kurt Grote, Olympic medalist - swimming
  • Nancy Hogshead, Olympic medalist - swimming
  • Jim "Catfish" Hunter - professional baseball player
  • Jackie Joyner-Kersee, Olympic medalist - track
  • Bill Koch, Olympic medalist - cross-country skiing
  • Greg Louganis, Olympic medalist - diving
  • Tom Malchow, Olympic medalist - swimming
  • Debbie Meyer, Olympic medalist - swimming
  • Art Monk - professional football player
  • George Murray - wheelchair athlete & Boston Marathon winner
  • Robert Muzzio - decathlete
  • Dennis Rodman - professional basketball player
  • Jim Ryun, Olympic medalist - track
  • Alberto Salazar - marathon runner
  • Isaiah Thomas - professional basketball player
  • Amy VanDyken, Olympic medalist - swimming
  • Dominique Wilkins - professional basketball player

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