Asthma Exercise. What Is Exercise-Induced Asthma And How Can Be Managed?

While some topics may be controversial when it comes to exercise, all healthcare professionals and scientists agree on this one: exercise is good and everyone should have a fitness routine. There are hundreds of health benefits of staying active including improved strength, increased energy, maintain balance, and thus reduced risk of falls and injuries; helping prevent or manage many diseases including high blood pressure,  heart conditions, arthritis, stroke, diabetes, osteoporosis, and at least 8 types of cancer. Regular exercise also correlates with better sleep, reduced levels of anxiety, stress, and depression as well as better brain function. To no surprise, exercise was also associated with increased longevity- not also lifespan but also health span.


About Exercise-induced Asthma 

Many cases of asthma are related to allergies and are triggered by allergens. Yet, exercise can also be a trigger for asthma attacks or worsening of the symptoms. This condition is known as exercise-induced bronchoconstriction (EIB) , labeled in the past exercise-induced asthma. Affecting 40- 90% of people with asthma and up to 20% of those without asthma,  EIB is a condition that particularly affects teenagers and young adults. EIB is defined as a transient and reversible contraction of the muscles of the airways related to exercise. Sometimes there are no symptoms at all. Other times, coughing is the only symptom experienced. Yet, others may develop more symptoms characteristic of asthma-like wheezing, chest tightness, and shortness of breath. 

When symptoms occur, they do not develop immediately after starting the exercise, but during the workout, get worse for 5-10 minutes after stopping exercise. Some individuals may experience more symptoms 4-12 hours post-workout and may take up to one day to resolve. 

What Causes EIB And How Do You Know You Have EIB? 

Your breathing naturally changes when you exercise. You breathe deeper and faster because the body needs more oxygen. The air you breathe in is dryer and cooler than the air you breathe out. This combination of cold and dry quality of the air is what triggers the muscle of the airways to constrict. Exercising outdoors when the air is even cooler and dryer will make the symptoms worse than exercises performed indoors in the warm, humid air. Other environmental factors that can trigger EIB include high pollen counts, polluted air, including smoke, strong fumes and odors, and a viral infection like cold. 

Based on physical examination, medical history, and lung tests a doctor can diagnose the EIB. The doctor will measure the breathing before, during, and after exercise to test the lung function. 

 Forced expiratory volume (or FEV1) is defined as the maximum amount of air that is forcefully exhaled in one second.  FEV1 is a marker of the degree of airway obstruction caused by asthma and is evaluated during a lung test called spirometry.  Fractional Excretion of Nitric Oxide (FENO) testing is a newer test that may replace FEV1 and spirometry to diagnose  EIB as well as the severity of EIP.  

Should You Exercise If You Have Asthma, Including EIB? 

Yes, you should exercise, but choose wisely how you exercise.  Although exercise can trigger symptoms, it also has paradoxically been shown to improve EIB severity, as well as pulmonary function and decrease airway inflammation in individuals with asthma and EIB.

The development of EIB occurrence is dependent on the type of sport you play. There are high-risk sports that should be avoided, and also low-risk sports that can be practiced regularly. It is important to consult with a doctor before starting an exercise program. It is also important to keep track of any symptoms you may experience during the exercise and adjust the training as needed. Many people, including elite athletes with EIB, can perform and achieve great success in many sports. While each person is different and will respond differently to one sport or another, there are some sports that are more likely to trigger symptoms and others that are safer if you have EIB. 

What Is The Best Exercise For Asthma?

Low-risk workouts (that are less likely to trigger EUB) include sports based on short bursts of exercise like baseball, gymnastics, sprints, high-intensity interval training (HIIT), tennis, fencing, boxing, weight lifting, and martial arts. Walking, golfing or leisure biking, and swimming in warm water in a humid environment are also good choices. 

There are also medium-risk sports- they aren’t the best exercises but can be practiced if they don’t aggravate the symptoms. Medium risk sports include football, soccer, rugby, cricket, field hockey, and other similar sports where a person won’t perform more than 5-8 minutes of continuous exercise. 

What Exercise Is Bad For Asthma?

 High-risk sports are considered workouts that involve long episodes of exercise (more than  5 – 8 minutes) in cold, dry environments or pools which contain chlorine.  Examples of sports that should be avoided include cycling, long-distance running, triathlons, skiing, ice hockey,  skating, high altitude sports, swimming in chlorinated pools. 

In addition to incorporating a workout routine, EIB may require prescription medication. According to the American Thoracic Society, the first-line therapy is short-acting beta 2 agonists which should be used 5 to 20 minutes (ideally 15 minutes) before exercise. If symptoms are not well controlled, additional medication with corticosteroid could be added to the treatment plan. Mast cell stabilizers are also an option and antihistamines could be useful in case of allergies. An asthma specialist will provide a treatment plan, with recommendations about how to prevent symptoms and how to manage an asthma attack. 

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