Asthma, Exercise-Induced

When you exercise intensely, your airways (the tubes that carry air to your lungs) might narrow or tighten. This is called exercise-induced asthma, or more formally, exercise-induced bronchoconstriction. It's like your lungs are having a temporary asthma attack triggered by physical activity.

This narrowing of the airways can cause a number of symptoms, including difficulty breathing (shortness of breath), a whistling sound when you breathe (wheezing), coughing, and other discomfort. These symptoms often happen during or right after exercise.

Importantly, while many people with asthma experience this, it's also possible for people without asthma to have exercise-induced bronchoconstriction.

Fortunately, most people who have this can still exercise and stay active. Treatment focuses on managing symptoms. This might involve taking medicine for asthma, and also taking steps to prepare for exercise. Things like warming up before intense physical activity, and avoiding exercising in very cold or dry air can help prevent these symptoms.

Exercise-induced bronchoconstriction (EIB) is a condition where your airways narrow after physical activity. This usually happens during or right after exercise. The symptoms can stick around for an hour or more if you don't treat them.

EIB often causes these problems:

• Coughing: A persistent cough that might feel worse after exercise.
• Wheezing: A whistling sound when you breathe, especially when you're active.
• Shortness of breath: Feeling like you can't get enough air, making it hard to breathe deeply or keep up with your usual pace.
• Chest tightness or pain: A feeling of pressure or discomfort in your chest.
• Tiredness during exercise: Feeling unusually fatigued or exhausted while exercising, even if you're used to the activity.
• Lower than expected performance: Not performing as well as you usually do during sports or other physical activities. This could be due to the breathing problems.
• Avoiding physical activity: Sometimes, especially in young children, the discomfort from EIB can lead them to avoid exercise altogether. This can be a significant problem for their development and enjoyment of physical activity.

If you experience these symptoms after exercise, talk to a doctor. They can help diagnose EIB and recommend ways to manage it.

See a doctor if you have symptoms of exercise-induced asthma. This condition makes your airways narrow when you exercise, causing breathing problems. Other issues can cause similar symptoms, so seeing a doctor for a proper diagnosis is important.

Get immediate medical help if you are having:

• Sudden worsening shortness of breath or wheezing. This means your breathing is becoming increasingly difficult.
• No improvement after using your prescribed asthma inhaler. If your asthma symptoms don't get better after using your rescue inhaler, seek immediate medical attention.

Exercise-induced bronchoconstriction (EIB) is a condition where your airways narrow during or after exercise, making it harder to breathe. Scientists aren't entirely sure why this happens. While it was once thought that cold air was the main problem, more recent research suggests that dry air is a more significant factor.

Cold air naturally has less moisture than warm air. When you breathe in cold, dry air, it can dry out the lining of your airways. This drying effect causes the airways to narrow, making breathing more challenging.

Beyond the dryness of the air, other factors can also irritate your airways and trigger EIB. These might include chlorine in swimming pools, or other fumes. These irritants can inflame the lining of your airways, leading to similar breathing problems.

Exercise-induced bronchoconstriction (EIB) is a narrowing of the airways in the lungs that happens during or after exercise. It's more common in certain groups of people.

Who is more likely to get EIB?

• People with asthma: A significant percentage (around 90%) of people with asthma also experience EIB. This means if you have asthma, you're more prone to having your airways tighten up during or after exercise. However, it's important to know that EIB can also affect people who don't have asthma. It's not exclusive to asthma sufferers.

• Athletes, especially elite athletes: While anyone can get EIB, it's more frequently seen in athletes, particularly those at a high competitive level. The demands of intense physical activity can trigger the narrowing of airways in susceptible individuals.

What makes EIB more likely?

Several factors can increase the risk of EIB or trigger an attack. These include:

• Dry air: Dry air can irritate the airways and make them more susceptible to narrowing.

• Cold air: Cold air can also irritate the airways, much like dry air. This is why many athletes experience EIB more often in colder weather.

• Air pollution: Pollutants in the air can irritate and inflame the airways, potentially leading to EIB.

• Chlorine in swimming pools: Chlorine is a common irritant, and can trigger bronchoconstriction, especially in individuals sensitive to it.

• Indoor gym environments: Fumes from various sources, like perfumes, paints, new equipment, or even carpets, can irritate the airways and lead to EIB in some people.

• Activities requiring deep breathing: Activities like long-distance running, swimming, and soccer, often involve extended periods of deep breathing. This increased demand on the lungs can make some individuals more prone to EIB.

If you don't get exercise-induced bronchoconstriction (EIB) treated, it can cause problems. This happens when your airways narrow during or after exercise.

This can lead to:

• Severe breathing problems: EIB can make it hard to breathe, especially if you already have asthma that isn't well controlled. In serious cases, it could even be life-threatening. Imagine feeling like you can't catch your breath, or your chest feels tight. That's the kind of difficulty you might experience.
• A harder time enjoying activities: EIB makes exercise tough. This can make it hard to play sports, go for runs, or just enjoy physical activities. It can also impact your overall quality of life, as you might avoid activities you used to love. You might feel less energetic or have less stamina.

To figure out if you have exercise-induced asthma, your doctor first asks about your health history and does a physical exam. They might also run some tests to check your lungs and make sure it's not something else.

One common test is called spirometry. This test measures how well your lungs work when you're not exercising. A special machine, called a spirometer, measures how much air you breathe in, how much you breathe out, and how fast you breathe out.

Your doctor might have you do the spirometry test again after you use a medicine that opens up your airways. This medicine is called a bronchodilator. The doctor compares the results of the two tests to see if the medicine improved your breathing. This first lung test helps rule out other lung problems like chronic asthma.

A spirometer is like a special tool that measures how much air you can breathe in and out, and how long it takes you to fully exhale after a deep breath.

To test for exercise-induced bronchoconstriction, you'll likely exercise on a treadmill or other machine until your breathing gets faster.

The exercise needs to be hard enough to cause your symptoms. Sometimes, the doctor might have you do a real-life exercise challenge, like climbing stairs, to see if it triggers your breathing problems. The doctor compares your lung function before and after the exercise to see if your breathing gets worse.

Another test uses a substance that causes the airways in some people to narrow, like methacholine. This is followed by a spirometry test to check how well your lungs work after the substance is inhaled. This test mimics the way exercise might trigger your breathing problems.

Managing Asthma Before Exercise: Medications and Tracking

Your doctor might prescribe medicines to help you manage asthma, especially before exercise. Some medicines are taken daily to control asthma long-term, while others are taken just before physical activity.

Before Exercise:

If your doctor recommends a medicine to take before exercise, they'll tell you exactly when to take it relative to your workout. This is important because timing matters.

Daily Medications for Long-Term Control:

Doctors often prescribe daily medications to control underlying asthma. These are used if pre-exercise treatment isn't enough. These are usually taken every day. Some examples include:

• Leukotriene Modifiers: These medicines reduce inflammation in your airways. You take them by mouth, and they can be used daily or before exercise, but at least two hours before you work out. Important note: These medicines may cause changes in mood or behavior, and even thoughts of suicide. Talk to your doctor right away if you notice any of these changes.

• Short-Acting Beta Agonists (SABAs): These are inhaled medicines that quickly open up your airways. Common brands include albuterol (ProAir, Proventil, Ventolin) and levalbuterol (Xopenex). You shouldn't use these every day, as this can make them less effective over time. They're best used just before exercise.

• Ipratropium (Atrovent): This inhaled medicine also helps relax your airways. It can be effective for some people. A generic version can also be used with a nebulizer (a machine that helps you breathe in the medicine).

• Inhaled Corticosteroids: These medicines help reduce inflammation in your airways. They work best when used regularly, but you might notice improvements within a few weeks.

• Combination Inhalers: These contain a corticosteroid and a long-acting beta agonist (LABA) – another medicine that relaxes airways. Your doctor may prescribe these for long-term control, or recommend them for use before exercise.

Keeping Track of Your Asthma:

It's helpful to keep track of how your asthma is managed. This helps your doctor adjust your treatment plan as needed. Record:

• How many puffs of your inhaler you use each week.
• How often you use your pre-exercise inhaler to prevent asthma symptoms.
• How often you use your pre-exercise inhaler to relieve symptoms during exercise.

If you're using your inhaler frequently, either daily or for symptom relief, your doctor may adjust your long-term control medication. This is a normal part of managing asthma.

Exercise is a crucial part of a healthy lifestyle, and this is true even for people with exercise-induced bronchoconstriction (EIB). EIB is a condition where exercise causes the airways in the lungs to narrow, making it hard to breathe. While medication is important, there are also steps you can take to help prevent or reduce EIB symptoms.

If your child has EIB, it's essential to talk to their doctor about creating a personalized action plan. This plan will be a detailed guide, outlining exactly what to do before, during, and after exercise. It will include instructions for teachers, nurses, and coaches, explaining:

• Warm-up: Before any workout, do about 15 minutes of gradually increasing activity. This helps prepare your body and lungs for the exercise. Think of it like warming up your muscles before a race.

• Breathing Techniques: Breathe through your nose as much as possible before exercising. Your nose helps warm and moisten the air, protecting your lungs from the cold and dry air that can trigger EIB.

• Protecting Your Lungs from Irritants: Wear a scarf or face mask, especially when exercising outdoors in cold, dry conditions. This helps filter out irritants like dust and pollen that can make EIB symptoms worse. Also, if your child has allergies, avoid exercising when pollen counts are high. Similarly, try to avoid areas with high air pollution, such as busy roads with lots of traffic.

• Medication and Treatment: The plan will clearly explain what medications your child needs and when to take them. It will also detail what to do if your child experiences symptoms during exercise, such as wheezing or shortness of breath. This includes knowing what actions to take to help your child if they have difficulty breathing.

In short, a comprehensive action plan is crucial for managing EIB, ensuring that everyone involved understands how to best support your child's needs during exercise.