Asthma & Allergy Advocate

Working Out With Ease, Not Wheeze
Exercise-Induced Asthma & Bronchospasm
from the Spring 1996 issue of the ADVOCATE

On a sunny afternoon, you are jogging down the parkway and have reached a steady speed. Suddenly you begin wheezing so hard that you have to stop, interrupt your running stride, and take out your inhaler. Whether you are a seasoned or novice athlete, having a workout interrupted by asthma symptoms is frustrating. If this has happened to you, you're not alone: many people - up to 85% of asthmatics - have symptoms of wheezing during or following exercise. In fact, even many non-asthmatic patients with allergies or a family history of allergy experience bronchospasm or constricted airways caused by exercise. Other symptoms can include coughing and chest tightness that may occur five to ten minutes after exercise.

Exercising in cold air and conditions of low humidity tends to worsen symptoms, since both are thought to increase heat loss from the airways. Nasal blockage also worsens exercise-related asthma because the air cannot be humidified and warmed in the nose. Air pollutants such as sulfur dioxide, high pollen counts, viral respiratory tract infections, and hot, muggy air also increase the severity of wheezing during or following exercise.

Activities that cause wheezing
(in order of severity)
Free running (most likely to induce asthma)
Treadmill running
Swimming (least likely to produce symptoms)

Testing for Exercise-Induced Asthma & Bronchospasm
Step 1A patient history is taken.
Step 2A breathing test is done while the patient is at rest to see if the patient has undiagnosed asthma. This test may be repeated after exercise.
Step 3Specialized tests may be performed, which can include cycling, running or treadmill tests. These are then followed with a breathing test.

Select your exercise
Carefully select your exercise activities. Activities such as walking, light jogging, leisure biking, and hiking may be fine for those who have problems with strenuous outdoor sports that involve heavy running. However, it is important that patients with asthma or exercise-induced bronchospasm get pre-treatment with proper drugs to allow them to participate in any activity they choose.

Swimming is often considered the sport of choice for asthmatics and those with a tendency toward bronchospasm, because in addition to toning upper body muscles, its positive factors include a warm, humid atmosphere and year-round availability. During swimming, the body's horizontal position also may help to mobilize mucus from the bottom of the lungs. Other activities recommended for those with asthma include sports that involve using short bursts of energy, such as baseball, football, wrestling, short distance track and field events, golfing, gymnastics, and surfboarding.

Cold weather events, such as cross-country skiing and ice hockey, or long-distance, non-stop activities like basketball, field hockey or soccer are more likely to aggravate airways. However, many asthmatics have found that with proper training and medical care, they are able to excel as runners or even basketball players.

Use prevention before a workout
Drugs administered prior to exercise, such as albuterol, metaproterenol, terbutaline, cromolyn sodium, nedocromil, and theophylline are all helpful treatment options in controlling and preventing exercise-induced bronchospasm. However, it is very important for everyone with exercise-induced asthma to have a breathing test at rest to assure that they do not have undiagnosed chronic asthma.

Avoid triggers
Athletes may need to "take it easy," restricting exercise and workouts when they have viral infections, during times when pollen and air pollution levels are high, or when outdoor temperatures are extremely low.

Warm up before working out
It is important that athletes do warm-up exercises and stretches before exercising. These make for a better, safer workout, since they slowly increase breathing levels and have been shown to alleviate chest tightness.

For years, asthmatic children and adults alike felt that they could not participate in athletic programs and recreational sports due to their "handicap." It was thought that asthmatics could not and should not take part in team sports and vigorous activities at the risk of aggravating their asthma. Today, with proper detection and treatment, those affected by exercise-induced asthma and bronchospasm can participate with those who do not have asthma on a level playing field. Most asthmatics can become accomplished in a wide variety of sports, exercise, and recreational activities, which are beneficial to both physical and emotional health and well-being.

Ask your allergist for more information on exercise-induced asthma and bronchospasm.

See also our Tips to Remember Series for additional information.

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