In the summer, we are outdoors—and hopefully exercising—more often. About 10% of people who exercise will get exercise-induced bronchospasm (EIB). Symptoms may include wheezing, excessive shortness of breath, chest tightness, or just coughing beginning 5 to 10 minutes after exercise. EIB occurs most frequently in persons with asthma, particularly those whose asthma is not well controlled. Various studies show that up to 90% of people with asthma have EIB. But it can also occur in isolation—in a person without asthma.
Why Does Exercise Trigger Bronchospasm?
When we exercise, we need more air to keep our muscles oxygenated and working properly. This requires more rapid breathing. In susceptible folks, this triggers release of chemicals from mast cells (allergy cells) that cause narrowing of the airways in the lungs (bronchospasm). The more rapid the breathing, the more severe the attack might be. Thus, running is more likely to provoke an attack than jogging, and jogging more so than walking.
The mechanism is related to cooling and drying of the airways; hence, running in cold, dry air is worse than warm, humid air. The underlying state of the airways might make it worse, too. For example, some asthmatics only have problems with EIB during their pollen allergy seasons, after an upper respiratory infection, or when they have been previously exposed to a cat or other irritant. Irritants also can come into play when exercise is performed on days with poor air quality due to pollution.
Typically, the airways dilate during exercise. About 5 to 10 minutes post-exercise is when the airways narrow and bronchospasm occurs. It will usually spontaneously resolve in 30 minutes or so.
Can It Occur Without Exercise?
EIB can occur without exercise, too. Anything that results in breathing in and out rapidly can trigger it, particularly in the asthmatic. This is how asthma came to be mistakenly called an “emotional disease”: a hundred years ago, when their laughing or crying child started wheezing, parents were convinced the asthma attacks were emotional. But we know now that asthma is not an emotional disease.
A Simple Treatment
The treatment, which involves prevention, is fairly simple. We tell all asthmatics to use a short-acting beta agonist (the rescue inhaler), such as albuterol, 15 minutes prior to exercise. But you should check with the doctor that prescribed this, as there might be other issues she or he will want to discuss with you about exercise.
There are other forms of these medications that last longer, and can be useful in keeping a child protected for the entire day at school. If there is underlying asthma, it should be maintained in tip-top shape with other controller medications, as well. But even with adequate medications, in some patients in certain situations, such as extreme exercise in frigid air, EIB can be difficult to control.
Enjoy your summer safely, and hopefully with a lot of exercise—and laughter, too.
To find an excellent doctor who is right for you, please call our Physician Referral Service at 866.804.1007.