How to manage exercise-induced asthma

You lace up your running shoes and hit the pavement. But just five minutes into your workout, you notice that your chest is feeling tight. You might even experience some coughing and wheezing. This is the kind of experience that can happen to people who have exercise-induced asthma. (Yes, even athletes.) 

Exercise-induced asthma is the appearance of asthma symptoms that are triggered by strenuous exercise. Here’s what to know about living with this condition—and managing it so you can keep on sweating.

What is exercise-induced asthma?

Asthma is a chronic condition that affects your lungs. When you experience an asthma attack, the muscles around your airways tighten up, which restricts the flow of air. Additionally, the lining of your airways becomes swollen and inflamed, which also affects airflow. Your lungs may also produce more mucus, which can clog airways, making it harder to breathe.

Exercise-induced asthma is the term used for the narrowing of the airways that occurs when you exercise. Many experts now prefer the term “exercise-induced bronchoconstriction” or EIB because they feel it’s a more accurate term. Exercise triggers the narrowing of the bronchi, or airways, which triggers symptoms, but exercise isn’t the root cause of the asthma, according to the Mayo Clinic.

According to the American College of Allergy, Asthma & Immunology (ACAAi), not everyone who has exercise-induced bronchoconstriction has asthma, but as many as 90% of people with asthma also have exercise-induced bronchoconstriction. If you only develop symptoms when you exercise, you might have isolated exercise-induced bronchoconstriction.

Exercise-induced asthma symptoms

What does it feel like to experience an exercise-induced asthma attack? It’s very similar to an asthma exacerbation that isn’t caused by physical activity.

Symptoms of exercise-induced asthma include:

• Coughing
• Shortness of breath
• Wheezing
• Chest tightness or pain
• Fatigue during exercise

You may wonder how long after you begin exercising that you’ll start to develop symptoms. “It’s pretty fast,” says Mandy DeVries, the director of education at the American Association for Respiratory Care (AARC). Usually symptoms will start within five to 10 minutes. The symptoms can last as long as 15 minutes after you finish your workout, according to the ACAAI.

It’s not unheard of for people to confuse exercise-induced asthma with a simple lack of conditioning. People who are out of shape might feel some chest tightness or shortness of breath after a few minutes of vigorous exercise, and those symptoms are very similar to those of exercise-induced bronchoconstriction. But the symptoms are more severe in someone who has EIB.

What causes exercise-induced asthma?

If you have EIB, your airways will narrow in reaction to the physical activity, according to the ACAAI. That’s when you experience those symptoms like chest tightness and shortness of breath.

Why does it happen? Normally, when you inhale air through your nose, that air travels through your nasal mucosa, which warms and moisturizes the air, preparing it for the airways in your lungs.

But when you exercise, you may be breathing harder and faster, and that may not give your nasal mucosa a chance to warm and hydrate that air. The drier-than-usual air can be irritating to your lower airways. “That can also cause you to have spasming of the airways,” adds Frank Coletta, MD, chief of critical care medicine and the associate director of the Center for Sleep Medicine with Mount Sinai South Nassau in New York.

What to do if you have an asthma attack while exercising

If you start to cough or wheeze a few minutes into your workout, don’t press on. “If somebody is having symptoms, they need to stop or at least walk, rather than continuing doing hard exercise,” says Colleen McGovern, Ph.D., MPH, RN, an assistant professor at the University of North Carolina at Greensboro’s School of Nursing.

You should also use your short-acting or quick-relief inhaler, also known as a rapid-acting bronchodilator. Short-acting beta 2-agonists, or SABAs, work quickly to open up your airways. In fact, they can take effect in as little as 15-20 minutes, and the effects can last four to six hours, according to the Cleveland Clinic. 

If you stop and use your inhaler and your symptoms subside, you may be able to resume your activity in a little while. Dr. Coletta suggests waiting 15 minutes or so.

“If someone is having symptoms every day when they are exercising, that is a problem,” McGovern says. “They need medical care.”

How to prevent exercise-induced asthma

Now for some good news. You can still exercise if you have exercise-induced bronchoconstriction. In fact, you should exercise because regular exercise provides so many benefits for your body and brain, including improving lung function. “It improves your overall cardiovascular condition,” notes Dr. Coletta. “It limits your risk for heart disease and stroke, and finally, people just feel better.”

Some people have even achieved some very impressive athletic feats while having EIB. Consider elite athletes like U.S. swimmer Tom Dolan who won two Olympic gold medals despite having exercise-induced asthma, and the elite English marathoner Paula Radcliffe.

According to the ACAAI, the sports that are most likely to trigger symptoms of EIB are cold-weather sports and sports that require constant activity, such as cross-country skiing, long-distance running, soccer, ice hockey, biking, and ice skating. Cold air tends to be dryer air, and when you rapidly inhale cold, dry air, it can irritate your bronchial tubes, which constrict and reduce airflow.

However, you don’t necessarily need to avoid doing any particular physical activity. But you do need to be proactive so you can prevent an attack from happening just when you’re starting to hit your stride.

Rescue inhalers

For example, if you just have exercise-induced asthma, you may need to always prepare for workouts by using your inhaler with a short-acting beta agonist, which will help open up your airways. These inhaled medications include albuterol and levalbuterol. Or your healthcare provider might suggest another type of inhaled medication such as ipratropium. 

Control medication

If you have asthma and exercise-induced asthma, you may need to take daily long-term control medication, too. Frequent use of SABA alone can gradually lessen their effectiveness. To prevent this phenomenon, if exercise is your only symptom trigger but is a frequent one, a long-term control medication may also be recommended in this circumstance. According to the Mayo Clinic, some options include inhaled corticosteroids such as:

• Fluticasone, available in products such as Flovent HFA
• Budesonide, available in products such as Pulmicort Flexhaler
• Mometasone, available in products such as Asmanex
• Beclomethasone, available in products such as Qvar Redihaler
• A combination inhaler that combines a corticosteroid and a long-acting beta agonist (LABA) such as Advair Diskus (fluticasone and salmeterol) or Symbicort (budesonide and formoterol) 
• Oral leukotriene modifiers such as Singulair (montelukast), Accolate (zafirlukast) or Zyflo (zileuton) 

Oral leukotriene modifiers can also be taken before exercising, with an expected onset of action within two hours.

Workout tips for people with exercise-induced asthma

If you’re exercising with exercise-induced asthma, the following tips can help minimize your symptoms.

• Warm up. It may be tempting to dive right into your workout, but you should make time to warm up first.
• Know your triggers. If you also have asthma, chances are that you know what tends to trigger an asthma attack or asthma exacerbation. It might be environmental irritants such as air pollution or a high pollen count. You may want to monitor these phenomena as well as any other potential allergens, so that, on days when there’s a high pollen count, you can take your workout indoors.
• Keep an eye on the weather. High temperatures, high humidity, sudden weather changes, storms, and cold temperatures have all been known to trigger asthma symptoms. Cold air or dry air are especially notorious for triggering bronchoconstriction, according to the Asthma and Allergy Foundation of America (AAFA).
• Bring your inhaler with you. “You should always carry an inhaler with you at all times,” says De Vries.
• Medicate beforehand. Speaking of inhalers, use your inhaler about 30 minutes before you exercise. “This way, when you exercise, you should be able to do so with wide open airways,” says Dr. Coletta.
• Wear a scarf. If you’re planning to exercise outside in the cold, wear a scarf around your neck and the lower part of your face, at least until you warm up, says McGovern. And try to breathe through your nose as much as possible.
• Cool down. Give your body a chance to readjust.

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What to expect long-term

There’s not a cure for asthma, including exercise-induced asthma. Even if you rarely experience symptoms, you still have asthma. “It’s more of a management issue,” explains McGovern.

The important thing is to acknowledge that you have this condition and develop an asthma action plan that will help you be prepared and prevent impact on your quality of life. This will include asthma management strategies and asthma medications or treatments to use as needed. 

If you’re regularly experiencing attacks when you try to exercise, it’s time to speak to your provider or respiratory therapist. You may need to revise your approach.