Asthma and exercise

An estimated 300 million people worldwide suffer from asthma, according to the World Health Organization. Some of these people only experience symptoms when exercising. If you cough, wheeze, have a tight chest or shortness of breath when you exercise, then you may have exercise-induced asthma or exercise induced bronchoconstriction (EIB). In people with EIB, the tubes that bring air into and out of your lungs narrow with exercise, causing symptoms of asthma.

Among people with asthma, exercise is just one of several factors that can induce breathing difficulties.

Causes
Researchers indicate that there may be more than one biological process that can lead to exercise induced bronchoconstriction. We know that in people who EIB, strenuous exercise sets in motion processes in your body that result in inflammation and the production of mucus in the airways. Symptoms of exercise induced bronchoconstriction can be triggered by multiple factors; researchers have found that cold air has less moisture than warm air and that cold, dry air causes the breathing tubes to narrow and makes it harder to breathe. Other factors that may act as triggers include:

·Air pollution

·High pollen counts

·Chlorine in swimming pools

·Respiratory infections or other lung disease

·Activities with extended periods of deep breathing, such as long-distance running, swimming or soccer.

·Other causes of symptoms with exercise may be that you are out of shape, have poorly controlled nasal allergies or vocal cord issues.

What are the symptoms?
You may have problems breathing within five to 20 minutes after exercise. Other symptoms may include:

·Wheezing

·Tight chest

·Cough

·Shortness of breath

·Poorer than expected athletic performance

·Feeling out of shape even when you're in good physical shape

·Avoidance of activity (a sign primarily among children)

If you are experiencing any of these symptoms with exercise, inform your doctor.

Diagnosing Exercise Induced Bronchoconstriction
Your allergist can help you by determining whether your symptoms are due to exercise induced asthma alone, a reaction to environmental allergens or irritants, or a sign of underlying asthma. They will review your history and will check how exercise affects your breathing by doing a breathing test at rest and may repeat this test after an exercise challenge. The breathing test is called a spirometry and measures the volume of air being inhaled and exhaled.

After diagnosing EIB, your allergist may prescribe medications that can treat and prevent your symptoms. Rescue (short acting bronchodilator) inhalers stop symptoms right away. They can be taken 15 to 30 minutes before exercise and work to prevent symptoms for two to four hours. A controller (inhaled steroid) inhaler may also be considered and works by decreasing the inflammation in the breathing tubes. The controller inhalers are taken daily to prevent symptoms and attacks.

In addition to medications, you can do the following to help relieve symptoms of EIB:

·Warm up with gentle exercises for about 15 minutes before you start more intense physical activity.

·Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.

·Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.

Recommended Activities
Sports that require only short bursts of activity are better for patients with EIB. These include volleyball, gymnastics, baseball, wrestling, golf, swimming, football and short-term track and field events. Although swimming requires constant activity, the warmth and humidity from the water make it easier to breathe. Walking, leisure biking and hiking are also good sporting activities for people with EIB.

Sports or activities that require constant activity in cold weather, such as cross-country skiing, ice skating or ice hockey may worsen symptoms. It is best to make sure your symptoms are well controlled so that you can continue to participate in all the activities you enjoy.

When to See an Allergist / Immunologist

If you feel that your symptoms are not well controlled, you may benefit from seeing an an allergist / immunologist. An allergist is a pediatrician or internist with additional specialized training in the diagnosis and treatment of problems such as asthma, allergic diseases, and problems with the immune system.  

Dr. Nena Kasmikha is an allergist/immunologist at Allergy & Asthma, PC in West Bloomfield. She is also the president of the Chaldean American Association for Health Professionals. She is affiliated with Beaumont Hospital, Providence Hospital, and DMC Hospital. You can make an appointment for evaluation by calling: (248) 626-5315.