Exercise and Asthma
OK, you have trained for the big race, but you know that
sometimes exercise makes you feel tight in the chest. Often you have a feeling
of shortness of breath along with wheezing.
What is going on? Are you going
to be able to run in the race? Is this
Not to worry. You
most likely have Exercise Induced Bronchospasm or EIB, sometimes also called
Exercise Induced Asthma (EIA). Many
famous athletes have had asthma or EIB, among them these Olympians:
Bill Koch - First American to win World
Cup in cross-country skiing
Greg Louganis - Olympic diver-USA 4
golds, 1 silver
Peter Maher - Olympic marathoner
Tom Malchow - Olympic swimmer gold
Mark Spitz - 1972 Gold medalist in
swimming - 7 golds at one Olympics, 9 overall.
Curt Harnett - Olympic cyclist and silver
Jackie Joyner Kersee - ranked among the
all-time greatest athletes in the women's heptathlon as well as in the women's
Here are some
statistics about EIB:
occurs in about 12% to 15% of the US general population and 10% of school
patients with chronic asthma, 70% to 90% have an exercise component to their
40% of patients with allergic rhinitis without asthma at other times also have
5% - 10%
of patients with EIB have no concomitant respiratory or allergic disease.
US Olympians in the 1984 Olympic Summer Games met the criteria for EIB.
the US Olympians in the 1998 Olympic Winter Games admitted the need for
medication for their exercise-induced symptoms.
of EIB in US Army recruits about 7%-- But no effect on physical performance
during basic training.
What are the symptoms?
Wheezing and/or tightness in the chest with
shortness of breath.
Symptoms start 5-10 minutes into vigorous
exercise or, often, 5-10 minutes after stopping.
If no medication is taken, it typically lasts
30-60 minutes and then goes away.
In 50% of those with EIB, there is a “refractory
period,” which begins 30 minutes to 4 hours after the start of exercise. During this period, an individual can continue
to exercise without being subject to wheezing or chest tightness. These individuals can use this to their
advantage to allow continued physical activity.
Some individuals experience a late reaction in
which symptoms recur 12 -16 hours after exercise and can last 24 hours.
So what is the cause of EIB?
Most researchers feel that it is due to
cooling and drying of the airways. Those
who have asthma have “twitchy airways.” When breathing in cold air, pollutants,
irritants such as smoke or strong odors or allergens such as pollen -- the
smooth muscles around the airways contract and the inside of the airways
produce excess mucous. When exercising,
especially in cold air, the individual breathes through the mouth so that the nose
does not have a chance to warm the air.
Also, the air is exchanged more rapidly, which means that the airways
are subject to drying, just like if a wind was blowing over a moist
surface. This causes the airways to be
irritable and the mucous membranes to swell and produce excess mucous. In
short, an asthmatic reaction occurs,
producing the symptoms described above.
So what can be done about it? Here are some suggestions:
When exercising in cold weather, put a scarf
over your nose and mouth. This will help
to make the air warmer. Avoid exercising
on high pollution days or high pollen days (f you are allergic to pollen). If that cannot be avoided, wear a pollen mask
while exercising. Some exercises may be
easier for those subject to EIB, including swimming, biking , surfing or
hiking. Your doctor may prescribe a
short acting bronchodilator medication, such as Proventil, ProAir or Ventolin,
to take 2 puffs 10-15 minutes before exercise.
If the expected duration of exercise is going to be more than 2-3 hours,
a longer-acting bronchodilator, such as Serevent or Foradil, may work
better. If you have already taken your
inhaler and start to wheeze while exercising, then additional puffs may be
taken. There are other medications which
may help, which include cromolyn sodium (Intal) taken 15 minutes before exercise
or Singulair, taken 2 hours before exercise.
Of course, if there is chronic asthma, that needs to be controlled with
regular corticosteroid inhalers or with dual-acting inhalers that have both an
inhaled corticosteroid and a long-acting bronchodilator.
And now—off to the races!!
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