| Exercise-induced asthma |
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Exercise can sometimes trigger symptoms in most people with asthma. For some people, exercise is their MAIN trigger. This is called exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB). Thankfully, having EIA does not mean a person can't or shouldn't exercise. With proper treatment, people with EIA can compete and succeed in sports at the highest levels. In fact, in the 1996 Olympic Games, a much higher proportion of athletes (>16%) had asthma than was found in the general population (<7%).
Exercising in cold, dry air is more likely to trigger EIA. Breathing through the nose and/or wearing a protective scarf or mask can help keep inhaled air warm and moist. Warm-up and cool-down periods can help prevent the abrupt changes that can trigger symptoms.
Symptoms and diagnosis
The symptoms of EIA are coughing, wheezing, chest tightness or shortness of breath associated with exercise. Some people with EIA notice symptoms soon after they start exercising. Most, though, have their major symptoms soon after they stop the activity.
Doctors can distinguish between EIA and 'being out of shape' by using spirometry or peak flow testing in response to exercise and to bronchodilator medication.
Pre-treatment before exercising
The key to treating EIA is pre-treatment. By taking medication before exercise, the airway narrowing can be simply and effectively blocked. A variety of medications may be used in EIA. This is a situation where short-acting inhaled beta-agonists (normally called relief or rescue drugs) can be used effectively to prevent or control symptoms. They are usually given 10 to 15 minutes before exercise, and can last up to 4 hours.
Inhaled cromolyn or nedocromil sodium can be used daily just before exercise, but their effect may last only for an hour or so.
Long-acting inhaled beta-agonists are sometimes used in the treatment of EIA. They are given at least 30 minutes before exercise and can last up to 12 hours. This can be wonderful, in that children can take the medicine before school and still be protected during sports or PE. However, these medicines may become less effective if used daily before exercise.
Leukotriene inhibitors may be taken orally before exercise for all day protection, and do not seem to lose their effectiveness.
Comparing sports
Swimming is often considered the sport of choice for people with EIA, because of the warm, humid environment. Sports that involve bursts of activity (football, baseball, etc.) are less likely to trigger EIA than those that demand continuous exertion (soccer, basketball, hockey, etc.). Still, Olympic athletes with asthma often compete in endurance sports. (Read about Olympic runner Jim Ryun).
With proper treatment and preparation, symptoms should be preventable with any sport. If a single medication is not sufficient, a combination of medicines may be needed.
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Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc., and Jacqueline A. Hart, M.D., Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma.
