A Fitness Plan to Combat Exercise-Induced Asthma

Exercise-induced asthma (EIA) is a reversible obstruction of the airways that occurs during or after vigorous physical exertion.

A majority of people with chronic asthma also have EIA. It also can occur in people who do not have asthma symptoms at any other time.

The percentage of Olympic athletes with EIA is nearly identical to the percentage of the general population with it. So, if you've been diagnosed with EIA, you probably don't have to sacrifice your favorite workouts or sports.

"It should be possible for the vast majority of people with EIA to do whatever exercise they want to do," says Henry Milgrom, M.D., director of an ambulatory pediatric allergy program in Denver. "After a diagnosis, the best way to keep active is to follow to your doctor's prescribed treatments."

What causes EIA?

The airways in the lungs of a person with asthma are overly sensitive to various stimuli. When these airways are irritated by one of these stimuli, the muscles surrounding the airways tighten. The mucus membranes that line the airways swell and secrete extra mucus. These responses cause the airways to become more narrow and make breathing difficult. People with EIA have airways that are overly sensitive to sudden changes in air temperature or dry air. Pollutants and allergens such as tobacco smoke, sulfur dioxide, nitrogen oxide (smog), molds and pollens can make EIA worse.

When not exercising, most people breathe through their nose, which warms the air and increases its humidity to about 90 percent before it reaches the lungs. During exercise, people commonly breath through their mouth, which does not allow the air to become sufficiently warm; breathing through the mouth moistens the air to only 60 to 70 percent humidity. One theory about the cause of EIA says that when this colder, drier air hits the lungs, the airways in the lungs have to moisten and warm the air. This causes changes in the chemistry and function of the lung, which leads to symptoms of EIA.

Do you have EIA?

A person with EIA may breathe normally at the start of vigorous exercise, or exercise that causes your heart rate to be 80 percent of your maximum heart rate, but begin wheezing, coughing or having difficulty breathing 10 or 15 minutes into it. Some people may have chest discomfort, stomachache or excessive fatigue during exercise or 5 to 20 minutes after vigorous exercise. Whether a particular exercise causes EIA depends on its intensity and the environmental conditions, including air temperature, humidity and any pollutants or allergens.

EIA is not always obvious in children. Some children with EIA tend to avoid physical activity, which can lead to weight problems, a poor self-image and avoidance of usual childhood or adolescent activities. It is difficult to determine if a child is simply out of shape or has EIA. Symptoms of EIA in children include becoming short of breath during or after vigorous exercise and taking more than a few minutes to recover; and coughing when he or she comes inside from playing in cold air.

Management of EIA

"Anyone who experiences symptoms of EIA should see a physician. Simple tests for lung function can confirm asthma," Dr. Milgrom says.

You can control the symptoms of EIA by avoiding triggers. Medication is also available; inhaled bronchodilator sprays can be used about 15 minutes before exercising. Long-acting sprays may be better for children with EIA because they often participate in unplanned exercise and may not have their medications on hand.

Here are other suggestions to help manage EIA:

• Get regular exercise, as recommended by your health care provider. Regular aerobic exercise may decrease the hypersensitivity of your airways.

• Avoid exercising in cold, dry air. When the weather is cold and dry, exercise indoors or cover your mouth and nose with a scarf to warm and humidify the air.

• Watch the air quality: Don't exercise outdoors when the pollen count or ozone level is high.

• If you have chronic asthma, exercise on days when your asthma is well controlled.

• Warm up gradually for 15 minutes, and cool down gradually; don’t start or stop suddenly.

• Choose activities and sports wisely. These sports may aggravate EIA: basketball, cycling, long-distance running, soccer, cross-country skiing, ice hockey and speed skating. Activities less likely to aggravate symptoms include baseball, football, golf, martial arts, sprinting, squash/racquetball, swimming, tennis, volleyball, weightlifting and wrestling.