Exercise is a common cause of asthma symptoms. It is often referred to as exercise-induced asthma (EIA). It is estimated that 80 to 90% of all individuals who have allergic asthma will experience symptoms of EIA with vigorous exercise or activity. For teenagers and young adults this is often the most common cause of asthma symptoms. 

Common symptoms of EIA are:

• Coughing, wheezing, chest tightness and shortness of breath
• Symptoms may begin during exercise and will usually be worse 5 to 10 minutes after stopping exercise
• Symptoms most often resolve in another 20 to 30 minutes and can range from mild to severe
• Occasionally some individuals will experience “late-phase” symptoms 4 to 12 hours after stopping exercise

What causes Exercise-Induced Asthma?

• When you exercise you breathe faster due to increased oxygen demands of your body
• Usually during exercise you inhale through your mouth, causing air to be dryer and cooler than when you breathe through your nasal passages. This decrease in warmth and humidity are both causes of bronchospasm.
• Exercise that exposes you to cold air such as skiing or ice hockey is more likely to cause symptoms than exercise involving warm and humid air such as swimming.
• Pollution levels, high pollen counts and exposure to other irritants such as smoke and strong fumes can make EIA symptoms worse.
• A recent cold or asthma episode can cause you to have more difficulty breathing.

Treatment and Management

With proper management and treatment people with EIA can participate safely and achieve their full potential. Taking medication prior to exercising is important in preventing EIA. Proper warm-up for 6 to 8 minutes before periods of vigorous activity will help also.

Inhaled medications taken prior to exercise are helpful in controlling and preventing exercise-induced bronchospasm. The medication of choice in preventing EIA symptoms is a short-acting beta2agonist bronchodilator spray used 15 minutes before exercise. These medications, which include albuterol, pirbuterol, and terbutaline, are effective in 80 to 90% of patients, have a rapid onset of action, and last for up to four to six hours. These drugs can also be used to relieve symptoms associated with EIA after they occur. 

In the school setting, these medications may be administered to children by school nurses. A long-acting bronchodilator spray that lasts up to 12 hours is also available. By using this before school, many children are able to participate in gym class and other sports throughout the day without needing short-acting sprays. 

If symptoms are not readily controlled by medications, patients should talk to their physician about using daily medication that treats the underlying asthma-the inflammatory process that is causing increased "twitchiness" or sensitivity of the airways. In addition to medications, a warm-up period of activity before exercise may lessen the chest tightness that occurs after exertion. A warm-down period, including stretching and jogging after strenuous activity, may prevent air in the lungs from changing rapidly from cold to warm, and may prevent EIA symptoms that occur after exercise.

Athletes should restrict exercising when they have viral infections, when temperatures are extremely low, or - if they are allergic - when pollen and air pollution levels are high. Pursed (narrowed) lip breathing may also help reduce airway obstruction.

Asthma and the Olympics 

According to a recent study, at least one in six athletes representing the United States in the 1996 Olympic Games had a history of asthma. Although 4-7% of the general population is reported to have asthma, the number of Olympic athletes who reported asthma was considerably higher. Out of 699 athletes, 117 (16.7%) were found to have a history of asthma, or to have used asthma medications, or both. Seventy-three (10.4%) of the athletes had active asthma, based on their need for asthma medication at the time of the games, or their need for medication on a permanent or semi-permanent basis. Among the Olympic athletes, asthma was most common among cyclists and mountain bikers and least common in athletes competing in badminton, beach volleyball, table tennis and volleyball. Interestingly, nearly 30% of the 1996 U.S. Olympians who had asthma or took asthma medications won team or individual medals in their Olympic competition, faring as well as athletes without asthma (28.7%) who earned team or individual medals.

Exercise is beneficial to both physical health and emotional well-being. Even if they are not striving for an Olympic medal, almost all people with EIA should be able to exercise to their full ability with appropriate diagnosis and treatment. 

Above information on exercise and asthma, and asthma and the Olympics from the American Academy of Asthma, Allergy, & Immunology, www.aaaai.org