Exercise-induced asthma (known medically as exercise-induced bronchoconstriction) is a condition in which physical activity triggers symptoms similar to asthma. This condition affects approximately 90% of people with asthma and up to 20% of the general population. It commonly affects children, high-performance athletes, and people living in more polluted areas.
Although it can cause breathing difficulties during exercise, most people can stay physically active with treatment. Medications and taking certain steps before exercising may help.
Symptoms of exercise-induced asthma typically begin within a few minutes after you start working out. They can take up to an hour to resolve after you stop exercising.
Common symptoms can include:
- Coughing (for some people, this is the only symptom)
- Wheezing (a whistling sound during breathing)
- Chest tightness or pain
- Shortness of breath
- Fatigue or unusual tiredness during exercise
- Reduced endurance during physical activity
- Sore throat
- Upset stomach
Some people experience late-phase symptoms, which occur 4-12 hours after exercising. These delayed symptoms are typically milder than the initial symptoms, but they can take up to 24 hours to fully go away.
Exercise-induced asthma occurs during intense aerobic activities, activities that raise your heart and breathing rates. Your body needs more oxygen during these activities, causing you to breathe more quickly and deeply. An increased breathing rate typically makes breathing through your nose difficult, so you inhale through your mouth.
Your nose usually warms, moistens, and filters the air you breathe. But when you breathe through your mouth, cooler, drier, or more polluted air may reach your lower airways and lungs. This can trigger airway inflammation and narrowing (bronchoconstriction), leading to asthma symptoms.
Several factors can worsen symptoms during intense activity, including:
- Dry (low-humidity) or cold air
- High pollen counts or other allergens in the environment
- Recent respiratory infections, such as the common cold or flu
- Irritants you can breathe in, such as air pollution, smoke, or chlorine fumes from a swimming pool
Triggers
Cold-weather sports and activities are most likely to trigger exercise-induced asthma, especially if they don’t involve much rest.
Swimming or exercising in chlorinated pools may trigger asthma symptoms, as chlorine and pool chemicals can irritate airways. The warmth and humidity from the water in the pool may also sometimes make breathing easier for people with exercise-induced asthma.
Examples of activities that may trigger symptoms include:
- Long-distance running
- Cross-country skiing
- Skiing and snowboarding
- Ice hockey or ice skating
- Soccer
- Basketball
- Field hockey
- Water polo
- Triathlons
Risk Factors
Exercise-induced asthma is more common among people with certain risk factors, such as:
- Asthma or allergies: About 90% of people with asthma experience exercise-induced asthma symptoms. A personal or family history of allergies may also increase the risk.
- Female sex: People assigned female at birth are more likely to experience exercise-induced asthma than people assigned male at birth.
- Pollution exposure: Living in an area with poor air quality may increase risk.
Most people experience some shortness of breath when exercising, but it’s important to see a healthcare provider if you regularly experience coughing, wheezing, chest tightness, or pain during or after exercise.
During your visit, your healthcare provider will likely ask about your symptoms. They may ask how often symptoms occur, what activities trigger them, and if you have a family history of asthma or allergies.
Your provider may also order an exercise challenge test to confirm a diagnosis. This test helps determine whether your airways narrow during exercise. It involves exercising, usually on a treadmill or stationary bike, for about six to eight minutes. The exercise intensity gradually increases until you reach your maximum exercise capacity.
Before, during, and after this test, your healthcare provider may measure your heart rate and breathing. They may ask you to breathe into a spirometer, a device that measures how much air you inhale and exhale, to help detect airway inflammation.
If your breathing function decreases with exercise, you may be diagnosed with exercise-induced asthma.
Treatment for exercise-induced asthma focuses on preventing asthma symptoms during exercise and relieving them when they occur. Medications may be necessary. Strategies such as staying hydrated and warming up before exercise may help.
Medication for Exercise-Induced Asthma
Medications for exercise-induced asthma help control airway inflammation to prevent or relieve symptoms. These medications include:
- Short-acting beta-agonists (SABAs): These are also called bronchodilators. They’re inhaled medications you take 15-30 minutes before physical activity. These medications help keep the airways open and prevent symptoms during exercise. An example is albuterol (sold under brand names like ProAir and Ventolin).
- Long-acting beta-agonists (LABAs): These drugs help reduce or prevent airway inflammation for up to 12 hours. They’re used with inhaled corticosteroids. An example is Serevent Diskus (salmeterol).
- Inhaled corticosteroids: Corticosteroids for exercise-induced asthma are inhaled medications used daily to control airway inflammation. Examples include Arnuity (fluticasone) and Alvesco (ciclesonide).
- Mast cell stabilizers: These inhaled medications prevent airway inflammation by blocking the release of inflammation-causing chemicals in your body. An example is Intal (cromolyn sodium).
Preventing Flares
Preventing symptoms is important for feeling good and being able to exercise regularly. Here’s how you can help decrease or prevent asthma symptoms during and after your workouts:
- Warm up gradually for at least 15-20 minutes before intense physical activity. Cool down for at least 15 minutes after exercise.
- Check local air quality, pollen counts, and avoid exercising outside when levels are high.
- Choose lower-intensity exercises or activities involving shorter bursts of exertion. Examples may include walking, weightlifting, golfing, boxing, or leisure biking.
- Drink plenty of water before and during exercise.
- Cover your mouth and nose with a scarf or mask while exercising in cold or dry weather. This can help warm and moisten the air you breathe.
Exercise-induced asthma, or exercise-induced bronchoconstriction, occurs when intense physical activity causes inflammation and narrowing in your airways, leading to symptoms such as coughing, wheezing, chest tightness, and shortness of breath.
It commonly affects children and people with asthma and allergies. With the right medications and precautions, you can stay active and comfortable with exercise-induced asthma.
