The Facts About Exercise-Induced Asthma

What is exercise-induced asthma and how does it differ from regular asthma? “Exercise-induced asthma (EIA) in most recreational athletes has these three qualities that make it different,” says Dr. Chris Randolph, an allergist and clinical professor at Yale University.

1. “It’s self-limited, so it eventually goes away on its own.”
2. “It’s refractile, so if you keep exercising for over a period of say two hours, the broncho-spasm response lessens until the point where it’s essentially extinguished.”
3. “With asthma in general, you have an inflammatory component that’s ongoing and can be life-threatening if you don’t treat it. But that’s not true of EIA. However, we do think that EIA is a manifestation of asthma in general.”

Listen to the weatherman

It may not be life threatening, but EIA can be life altering, as Olympic medalist Courtney Shealy knows. The swimmer was diagnosed in 1997 with EIA, after she found she was having trouble breathing during her conditioning workouts. “The doctor put me on some medication, but it was an as-needed thing, so not something I had to take daily,” says 29-year-old Shealy. But then, while competing in the 2003 Pan-American games in a stifling Dominican Republic climate, her asthma took a turn for the worse. After returning home to Athens, Georgia, Shealy was prescribed four more medications to keep her asthma in control. “In 1997, the exercise definitely triggered it, but then last summer, they attributed it to being in a very hot pool and hot weather conditions that must have aggravated it,” she says.

While in general, numerous things can trigger asthma (from pet dander to dust to environmental conditions), Randolph says allergies are a key trigger in EIA. “Inhaling allergens definitely play a role in worsening EIA, so it’s no surprise that about 90 percent of asthmatics and about 40 to 50 percent of people with allergic rhinitis have EIA,” he says. Other triggers include extreme weather conditions – the culprit behind Shealy’s worsening asthma. Extremely hot or cold weather does a number on the lungs.

What are your treatment options?

Generally, albuterol inhalers are taken preventatively before a workout. This cuts the chances of inflammation of your airway to avoid the airway narrowing. Marisa Spinosa, a teacher in Hamilton, Ontario, who plays soccer regularly, keeps two inhalers with her at all times. “The salbutamol inhaler is to take before I’m going to participate in any sport or physical activity. I take two puffs,” says 27-year-old Spinosa. “And if I have a cold or something else affecting my lungs, I take the fluticasone inhaler to clear up my lungs. Both are on an as-needed basis.”

While those are the common treatments for asthma, thankfully, there are other ways to control it too. Randolph notes that pre- and post-exercise sessions, warming up and cooling down, are key. “With EIA, cold or dry air causes the cells in the airway to be deregulated and shrink and release their mediators (substances in our bodies triggering asthma attacks). So in warming up and cooling down, the airway might release some mediators, but not a whole lot, so you don’t get any symptoms,” he says. “And then when you actually do exercise, you get less response because you’ve already released some of the mediators.”

That’s one coping technique that Natalie Hunt, a Los Angeles-based personal trainer, fitness competitor and model, relies on regularly to deal with her asthma while she exercises. “I warm up probably twice as long as any other person to get my lungs warm,” she says. “I just go at a really slow intensity and build up, because otherwise I’ll have an asthma attack in the first five minutes [of working out].”

Other coping mechanisms

• Avoid exercising in extreme weather conditions – something else Hunt relies on. “I never, ever exercise in the cold because it is very hard on my lungs. I need warm, humid air to function at my best,” she explains.
• Skip outdoor exercise on days where allergies might be heightened due to high pollen counts or smog alerts.
• Know your limits. Modify your workouts. The more you know about how your body reacts asthmatically, the more you can prevent any kind of severe attacks.

In the end, though, Both Randolph and those with asthma say it’s essential to keep exercising and not use it as an excuse to quit. “It’s important that you don’t baby yourself,” says Hunt. “Don’t use asthma as a crutch to say ‘I can’t do this.’ You’ll never get anywhere doing that, and if I’d had that mind-set, I wouldn’t be where I am today.”