Exercise-Induced Asthma (EIA)

Asthma is a chronic inflammation of the airways, which carry air to and from your lungs. This inflammation makes airways sensitive and prone to overreact when exposed to certain allergens or environmental factors called triggers. When faced with a trigger, muscles around the airways contract. The airways narrow, become more swollen, and in doing so produce excess mucus. You can do the math –the result is less air flow to the lungs and some difficulty breathing, YES THIS is  called an asthma attack.

Exercise-induced asthma is this difficulty breathing  that is triggered by physical activity. It is also called exercise-induced bronchospasm (EIB). The muscles contracting so as air passes makes the sound of wheezing

Twenty million Americans have asthma AND experience symptoms during exercise. However, many people without asthma may also experience asthma symptoms during physical activity. Myself included!

How do you know you have exercise-induced asthma?

The main symptom is difficulty breathing during exercise, which may be experienced as any of the following:

  • Coughing
  • Wheezing
  • Chest tightness
  • Chest pain
  • Extreme fatigue
  • Shortness of breath can’t touch your breath

Any of these symptoms can begin within five to twenty minutes of starting exercise, reach their worst point about five to ten minutes after stopping exercise, and then gradually resolve.  Take heart-Symptoms are often gone within 60 minutes, but can last longer.

In children, symptoms may be more subtle. For example, a child may complain of not being able to keep up with the others in sports activities or he or she may avoid participation in physical activity.

Causes of exercise-induced asthma?

It is unknown why people with EIA have overly sensitive airways. Having parents or siblings with asthma may increase your risk, as asthma tends to run in families. In addition, early-life exposure to irritants such as tobacco smoke, infections, and allergens may make airways more vulnerable.

Once your airways are vulnerable, an asthma attack is caused by a trigger. In the case of EIA, mouth breathing during exercise is the trigger. With EIA, your airways are sensitive to rapid changes in the temperature and humidity (wetness) of air. When you’re at rest, most breathing is done through the nose. Air is warmed and moistened in the nasal passages before it reaches the lungs. During exercise, though, most breathing is done through the mouth, which allows air to pass more quickly to the lungs without being warmed or moistened. When the colder, drier air coming through the mouth mixes with the warm, moist air in the lungs, it can be a shock to your airways resulting in asthma symptoms.

Sports that require continuous aerobic activity or are played in cold weather are most likely to trigger an EIA attack. EXAMPLES:

• Distance running

• Basketball

• Soccer

• Hockey (ice and field)

• Cross-country skiing

• Competitive cycling

Sports that are least likely to trigger an EIA attack are those that are less vigorous, require short bursts of activity alternating with breaks, or are done in a warm environment. These include:

• Walking

• Recreational biking

• Hiking • Swimming

• Short-distance running

• Track and field events

• Baseball or softball

• Golfing

• Football

• Volleyball

• Wrestling

• Gymnastics

• Downhill skiing or snowboarding

• Surfing

Diagnosis of Exercise-Induced Asthma

The doctor will ask about your medical history, give him or her  a careful description of your symptoms. It is likely that a breathing test will be preformed.

The breathing test is usually done in your doctor’s office. You’ll exercise for at least  six minutes on a treadmill or stationary bicycle. Before you begin and at several instances from two to 30 minutes after you stop, you will be asked to breathe into a meter device- a spirometer. The spirometer measures how much air you can exhale in one second—the forced expiratory value in one second or FEV1. A drop in the FEV1 of 12-15% from YOUR normal hints that you have EIA.

Your FEV1 can also be measured “out on the field” with the use of a  hand held device called a peak flow meter. Here you will be perform the activity that triggers your symptoms for at least  six minutes. Your breathing will be measured once before and several times after this exercise. A drop of 15-20% from YOUR normal in the FEV1 indicates EIA.

For added information, your doctor may attach a pulse oximeter to your fingertip. This is a painless, clothes-pin-like device that measures percentage of oxygen saturation in your blood. A chest x-ray may be warranted in certain cases.


Treatment of  Exercise-Induced Asthma

EIA cannot be cured.   But, with training and proper treatment, most people with EIA can control their symptoms and continue to be as physically active as they want.


Drugs that dilate –open up the bronchus (bronchodilators) are used to treat EIA

For 80-90% of persons, the use of an inhaled medication 15 minutes prior to exercise can prevent symptoms. The most commonly used medication is a short-acting ‘beta-2 agonist bronchodilator’, such as:

• albuterol

• pirbuterol

• terbutaline

These medications work quickly and last up to four to six hours. Bronchodilators make it easier to breathe by relaxing the muscles of the airways and allowing them to open wider, thereby allowing more air to pass through. As with any  other medication there are side effects. Most common are rapid heartbeat and shakiness.

It is important to know the correct techniques for using your inhaler-OTHERWISE you will not get the correct dose!  Keep it clean per instructions.

Short-acting bronchodilators can also be used to treat EIA symptoms once they begin. Your doctor should design an action plan for you-that is what to take and under what circumstances to prevent/treat an EIA attack. BE sure you are clear on the amount of medication to use and how often.



Be sure to tell your doctor about any other medicines you are taking for asthma or any other conditions- including over the counter and herbal preparations. NEVER – use non-prescription inhalers. Such inhalers contain a very short-acting drug that may not last long enough to relieve an EIA attack and may cause side effects.

Lifestyle management

Other tips for preventing or minimizing EIA:

1. If you smoke, QUIT.

2. Include a warm-up and cool-down with each exercise session.

3. Avoid exercise when you have a respiratory tract infection-cold, flu, or bronchitis.

4. In cold weather, wear a scarf over your mouth and nose to warm the air that you breathe in.

5. Avoid exercise in extremely cold temperatures.

6. If you have known allergies, avoid exercise when the pollen counts and air pollution levels are high.


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