Have you ever been in the middle of a run or a spin class when suddenly you started to wheeze and had trouble catching your breath? You might have exercise-induced asthma (EIA). EIA is a narrowing of the airways during exercise that makes it hard to breathe.
Don’t just stop exercising. Exercise is good for you in so many ways, and activity might even reduce your asthma symptoms over the long term. Learn how to treat EIA so you don’t have to give up your workouts.
Asthma is a condition that makes your airways swell up and become irritated, inflamed, and narrow. When you have EIA, your airways constrict when you play sports or exercise. Doctors call this condition exercise-induced bronchoconstriction (EIB).
Symptoms of Exercise-Induced Asthma
During your workout or shortly afterward, you may notice that you’re short of breath. Other symptoms include:
- chest tightness
- chest pain
- lower endurance
- sore throat
Your symptoms might be more severe when you do more intense bouts of exercise.
You might not start coughing or wheezing until you’ve been working out for a few minutes. The symptoms will often get worse five to 10 minutes after your exercise session ends. Some people don’t see symptoms until several hours later. That’s a phenomenon called late-phase symptoms.
Causes of Exercise-Induced Asthma
Exercise doesn’t cause asthma, but it can set off symptoms. Up to 90 percent of people with asthma have flare-ups when they work out. Even if you don’t have asthma, you can still develop breathing problems during exercise.
Your body needs extra oxygen to fuel your muscles when you exercise. You’ll typically start to breathe through your mouth to pull in more air. Breathing through your nose humidifies and warms the air. Air that comes in straight through your mouth is colder and drier. The cold, dry air sucks the moisture from your airways. This irritates and narrows them.
Your symptoms can also get worse if you’re exposed to certain irritating substances, including:
- air pollution
- chemicals such as pesticides or the chlorine in a swimming pool
Exercising while you have a cold or respiratory infection can also trigger an asthma attack.
Risk Factors for Exercise-Induced Asthma
You’re more likely to have EIA if you have a personal or family history of allergies. People who take part in cold-weather activities, such as skiing, ice skating, or ice hockey, are also more likely to have breathing problems. Intense or long periods of exercise, such as running a marathon, can also set off symptoms.
Diagnosing Exercise-Induced Asthma
Your doctor will start by asking questions about your asthma, how often you exercise, and when your breathing trouble tends to happen. You’ll also get an exam, which will include tests to see how well your lungs work.
Spirometry is a test in which you breathe into a device that measures the force of your breath in and out. The doctor might ask you to run on a treadmill or ride an exercise bike, and then do the spirometry test to see what happens to your breathing when you exercise.
Another type of test is a challenge test. Challenge tests simulate the triggers of EIA. During this test, you’ll breathe in a substance such as methacholine or mannitol. The substance will cause your airways to tighten if you have asthma. You may also get a bronchodilator after the test to reverse the effects. Your doctor will give you spirometry tests before and after you breathe in the substance.
Exercising with Asthma
Your doctor will help you write up a plan for preventing EIA. Taking asthma medicines can help you avoid attacks. You might only need to take medicine before you exercise. Or, you can take medicine every day to control your asthma long term.
Your doctor may prescribe any of the following medicines to take before you exercise.
Short-Acting Beta Agonists
Short-acting beta agonists, or bronchodilators, relax your airways to keep them open. To use, breathe in the medicine about 15 minutes before you exercise. The effects can last for up to five or six hours.
The following are common short-acting beta agonists:
Long-acting bronchodilators are taken 30 to 60 minutes before you exercise. They can prevent asthma symptoms for up to 12 hours.
Long-acting bronchodilators can trigger asthma attacks in some people, so only take them if you also use an inhaled corticosteroid.
Some long-acting bronchodilators include salmeterol (Serevent) and formoterol (Foradil, Perforomist).
Mast Cell Stabilizers
Mast cell stabilizers prevent the release of chemicals that are involved in allergic reactions. You should breathe them in 15 to 20 minutes before you exercise. Some mast cell stabilizers include cromolyn sodium (Nasalcrom) and nedocromil sodium (Tilade).
If taking medicine before you exercise isn’t enough, your doctor might recommend a medication to provide long-term asthma control.
Inhaled corticosteroids bring down swelling in your airways. They can take two to four weeks to start working.
The following are inhaled corticosteroids:
- fluticasone propionate (Flovent Diskus, Flovent HFA, Flonase)
- budesonide (Pulmicort Flexhaler)
- mometasone (Asmanex Twisthaler)
- beclomethasone (Qvar, Qnasl)
Another long-acting medication is a combination inhaler. Combination inhalers include:
- fluticasone propionate and salmeterol (Advair Diskus, Advair HFA)
- budesonide and formoterol (Symbicort)
- formoterol fumarate dihydrate and mometasone furoate (Dulera)
These drugs contain both corticosteroids and a long-acting beta agonist. You can use them daily and just before you exercise.
How to Prevent Exercise-Induced Asthma
If you have EIA, take your medicine as your doctor prescribed to prevent attacks. Check with your doctor before starting any new exercise program.
Try to stick with activities that won’t set off your symptoms. Sports that you do in short bursts are best. These include:
- indoor swimming
You may also try switching from a high-impact sport to a lower-intensity one, such as golf or lifting weights.
In addition to altering the type of exercise you’re doing, you can also try these tips:
- If you have seasonal allergies, work out indoors on days when the pollen count is high.
- On cold days, cover your face with a scarf or mask to warm the air before it gets into your lungs.
- Warm up for 10 minutes or so before your workout.
- Don’t exercise while you have a cold or other respiratory infection.
- Check your breathing while you exercise. You should stop exercising if you feel short of breath.
What to Expect
Taking medicine before you exercise and avoiding your asthma triggers should help you avoid asthma attacks. See your doctor if you take these steps and still have trouble breathing when you work out. You may need a new asthma plan.