Most people with asthma have worsening of their symptoms with exercise (exercise-induced bronchoconstriction), which is different than exercise-induced asthma, where asthma symptoms only occur with exercise.
The amount of exercise required to trigger symptoms in asthmatics varies from person to person, although the more vigorous the exercise, the more severe the symptoms. Exercise results in a cooling and drying of the airways, which leads to constriction of smooth muscle around the airways, causing worsening of asthma symptoms. Asthma symptoms usually get the worst as soon as airway re-warming occurs, such as when exercise stops, and continue for many minutes afterward.
Exercise-induced bronchoconstriction may be prevented and treated, allowing people with asthma to exercise more easily.
Prevention of Exercise-Induced BronchoconstrictionExercise-induced asthma may be prevented with exercising indoors away from cold, dry air. Certain activities performed in warm, humid environments (such as indoor swimming) may also help prevent symptoms. Exercising outdoors or in cold, dry air would likely worsen exercise-induced asthma symptoms.
Symptoms may also be minimized with drinking lots of fluids (staying hydrated), and performing appropriate warm-up activities prior to a full workout. Good control of nasal allergies may also help to control exercise-induced asthma symptoms.
The most drug-free way is for a person to experience a mild asthma attack as a result of an exercise warm-up activity. This sounds like a strange approach, but for about 40 minutes after this, a person can exercise without causing additional asthma symptoms. This is called the refractory period, and it is taken advantage of by many professional and Olympic athletes who may not be able to use typical asthma medications due to certain rules and regulations.
Exercise-induced asthma can also be prevented simply by using a rescue inhaler, such as albuterol, approximately 10 to 15 minutes before exercise. If the exercise is especially strenuous or prolonged, or symptoms occur anyway, albuterol may need to be re-taken every 2 to 4 hours as needed. Singulair (montelukast) has also been shown to be helpful in preventing exercise-induced asthma, even if it is taken at least 2 hours before the exercise is started. Intal (cromolyn), another inhaled asthma medication, can be used 10 to 15 minutes before exercise, with or without albuterol, and can be helpful in some cases of severe exercise-induced asthma.
Treatment of Exercise-Induced BronchoconstricitonSymptoms of exercise-induced asthma can be rapidly treated with albuterol or similar rescue medication. If no medication is available, symptoms will usually resolve without treatment over about 15 to 30 minutes once exercise has stopped.
If asthma symptoms occur with exercise, a person should stop exercising and use a rescue inhaler. If one isn’t available, the person should move to a warm area (indoors) and try to relax. When symptoms aren’t getting better within a few minutes, or are getting worse (such as the person’s lips are turning blue, they aren’t thinking clearly, are breathing rapidly or shallowly, or are wheezing or coughing uncontrollably), emergency medical care should be sought immediately (such as calling 911 or going to the closest emergency room).
Often, asthma that worsens with exercise is a sign of uncontrolled asthma. In these cases, asthma that worsens with exercise should be treated with a controller therapy, such as an inhaled steroid, and inhaled steroid/long-acting beta-agonist combination (such as Advair), or other controller medicine.
Long-acting beta-agonists, such as Serevent (salmeterol) or Foradil (formoterol), should never be used by themselves for any form of asthma. When used alone, these medicines stop working after about a month, and could potentially cause worsening asthma -- even if a person has more than just exercise-induced asthma.
Carlsen KH et al. Treatment of exercise-induced asthma, respiratory and allergic disorders in sports and the relationship to doping: Part II of the report from the Joint Task Force of European Respiratory Society(ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN. Allergy 2008: 63: 492-505.
McFadden ER, Jr. Exercise Induced Airway Narrowing. In: Adkinson NF, Yunginger JW, Busse WW, et al, eds. Middleton’s Allergy Principles and Practice. 6th edition. Philadelphia: Mosby Publishing; 2003:1323-1332. DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.