People with asthma should be encouraged to participate in physical activities,
exercise, and sports. Nevertheless, exercise can sometimes trigger symptoms
in most people with asthma. For some people, exercise is their MAIN trigger.
This is called exercise-induced asthma (EIA) or exercise-induced bronchospasm
(EIB). Thankfully, having EIA does not mean a person can't or shouldn't exercise.
With proper treatment, people with EIA can compete and succeed in sports at
the highest levels. In fact, in the 1996 Olympic Games, a much higher proportion
of athletes (>16%) had asthma than was found in the general population (7%).
Exercising in cold, dry air is more likely to trigger EIA. Breathing through
the nose or wearing a protective scarf or mask can help keep inhaled air warm
and moist. Warm-up and cool-down periods can help prevent the abrupt changes
that can trigger symptoms.
Symptoms and diagnosis
The symptoms of EIA are coughing, wheezing, chest tightness or shortness of
breath associated with exercise. Some people with EIA notice symptoms soon
after they start exercising. Most, though, have their major symptoms soon after
they stop the activity.
Doctors can distinguish between EIA and 'being out of shape' by using spirometry
or peak flow testing in response to exercise and to bronchodilator medication.
Pre-treatment before exercising
The key to treating EIA is pre-treatment. By taking medication before exercise,
the airway narrowing can be simply and effectively blocked. A variety of medications
may be used in EIA. This is a situation where short-acting inhaled beta-agonists
(normally called relief or rescue drugs) can
be used effectively to prevent or control symptoms. They are usually given
10 - 15 minutes before exercise, and can last up to 4 hours. This can eliminate
symptoms in more than 80% of people with EIA.
A lengthy warm-up period may reduce the need for medications.
Inhaled cromolyn can be used daily just before exercise as an alternative,
but the effect may last only for an hour or so.
Long-acting inhaled beta-agonists are sometimes used in the treatment of EIA.
They are given at least 30 minutes before exercise and can last up to 12 hours.
This can be wonderful, in that children can take the medicine before school
and still be protected during sports or PE. However, these medicines may become
less effective if used daily before exercise. Note: On November 18, 2005, the
U.S. Food and Drug Administration (FDA) notified manufacturers of Advair Diskus,
Foradil Aerolizer, and Serevent Diskus to update their existing product labels
with new warnings and a Medication Guide for patients to alert health care
professionals and patients that these medicines may increase the chance of
severe asthma episodes, and death when those episodes occur.
All of these products
contain long-acting beta2-adrenergic agonists (LABA). Even though LABAs decrease
the frequency of asthma episodes, these medicines may make asthma episodes
more severe when they occur. A Medication Guide with information about these
risks will be given to patients when a prescription for a LABA is filled or
refilled. See the FDA website for more information, at www.fda.gov.
Leukotriene inhibitors may be taken orally before exercise for all day protection,
and do not seem to lose their effectiveness.
Swimming is often considered the sport of choice for people with EIA, because
of the warm, humid environment. Sports that involve bursts of activity (football,
baseball, etc.) are less likely to trigger EIA than those that demand continuous
exertion (soccer, basketball, hockey, etc.). Still, Olympic athletes with asthma
often compete in endurance sports. (Read about Olympic runner Jim
With proper treatment and preparation, symptoms should be preventable with
any sport. If a single medication is not sufficient, a combination of medicines
may be needed.
National Asthma Education and Prevention Program Expert Panel Report: guidelines
for the diagnosis and management of asthma update on selected topics -- 2002. J
Allergy Clin Immunol. 2002 Nov;110(Suppl 5):S141-219.
National Asthma Education and Prevention Program Expert Panel Report 2:
guidelines for the diagnosis and management of asthma. Bethesda (MD):
U.S. Department of Health and Human Services, Public Health Service, National
Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul.
NIH Publications 97-4051.
Review Date: 5/16/2007
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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