A walk in the park was usually just that for Elizabeth Shuman. But last winter, she started having trouble breathing during one of her “power walks” – she felt short of breath and her chest felt tight. At first she thought she had a cold or respiratory infection. When the symptoms kept coming back, Elizabeth went to see her doctor and was diagnosed with exercise-induced asthma.
Up to 90 percent of people with chronic asthma experience asthma symptoms during and after exercise. If you have allergic rhinitis (hay fever) or a family history of allergies, you too could be at risk for coughing, wheezing, shortness of breath and chest tightness while you exercise or shortly after you’re done. If you’re in this second group, you may have “exercise-induced asthma,” a term doctors use to describe people who have asthma symptoms only when they exercise. It’s possible to have exercise-induced asthma without allergies or other asthma triggers.
If you have exercise-induced asthma, or have been diagnosed with chronic asthma and know that exercise is one of your triggers, treatment and prevention are the keys to getting back in the game.
Come In From the Cold
People with exercise-induced asthma have airways that are very sensitive to sudden changes in temperature and humidity, especially when breathing cold, dry air. Nasal passages act as a mini-sauna for the air we breathe – warming the air and adding moisture – in addition to filtering unwanted particles out of the air. But most people breathe through their mouths when they exercise, allowing cold, dry air (plus allergens and other irritants) to reach the lower airways. Mouth breathing is also common among athletes and patients with stuffy noses from colds, sinusitis and allergic rhinitis.
Other factors can lead to wheezing with exercise, including air pollution, high pollen counts and respiratory tract infections.
Symptoms of exercise-induced asthma usually appear 5 to 10 minutes after exercise starts or ends. In some cases symptoms can develop up to 10 hours after exercise, but there is some debate about whether this is really exercise related.
If you think you have exercise-induced asthma, make an appointment with a physician to confirm the diagnosis. The physician will take your medical history and have you perform breathing tests while resting and after exercise.
Manage With Medications: Many physicians prescribe inhaled bronchodilators (medication that opens constricted airways) for exercise-induced asthma. Taking an inhaled bronchodilator before exercise can help prevent the bronchospasms of exercise-induced asthma. These medications can also be used to relieve symptoms when they occur.
Other medical conditions, such as restrictive abnormalities and vocal cord dysfunction, can mimic the symptoms of exercise-induced asthma. If symptoms are not readily controlled with a bronchodilator and your physician has ruled out other possible causes of your breathing problems, talk to your physician about using daily anti-inflammatory medications to treat the underlying cause of asthma – airway inflammation. Medications are just one part of the puzzle in managing exercise-induced asthma.
Warm Up and Cool Down: In addition to medications, warm-up and cool-down periods may help minimize symptoms. Asthma symptoms occur due to rapid cooling and rapid warming of lower airways, which causes the airways to constrict. By making a gradual temperature shift, you lessen the chances of airway constriction and thus asthma symptoms.
Evaluate Your Environment: Athletes with exercise-induced asthma should keep exercise to a minimum when other potential asthma triggers are present (e.g., when an athlete has a viral infection, when it’s cold outside or when pollen and air pollution levels are high). Breathing through the nose or wearing a scarf during cold weather may also help by warming the air and filtering out allergens.
So many athletes – both professional and recreational – are being diagnosed with exercise-induced asthma that the National Athletic Trainers’ Association recently developed guidelines to familiarize trainers, health professionals, parents and coaches with asthma symptoms and treatments. Among the recommendations for athletic trainers:
- Have pulmonary function measuring devices, such as peak flow meters, at athletic venues and be familiar with how to use them.
- Schedule practices during times when pollen counts are low.
- Consider providing alternative practice sites for athletes with asthma.
Some activities are better than others for people with exercise-induced asthma. Swimming is often a good choice because it’s done in a warm, humid environment, plus the horizontal position may help move mucus from the bottom of your lungs. But if you have sensitivity to chlorine, try walking, leisure biking or hiking – these forms of exercise can be paced more readily than vigorous activities.
Strenuous and sustained physical activities generally trigger exercise-induced asthma. So team sports that require short bursts of energy, such as baseball, football, golfing or surfing may be better picks than sports requiring continuous activity such as soccer, basketball or long-distance running. Cold weather activities such as cross-country skiing and ice hockey are more likely to aggravate airways, but wearing a cold-weather mask or scarf over your mouth and nose can decrease symptoms by warming the air you inhale.
Using these tips, exercise-induced asthma shouldn’t keep you sitting on the sidelines.
First published: The MA Report, November/December 2005
Updated February 2009