What Is Exercise-Induced Asthma?

Exercise-induced asthma (EIA) is the more familiar term for what the medical community prefers to call exercise-induced bronchoconstriction. It occurs when the airways (bronchi) constrict in response to physical activity, resulting in typical asthma symptoms such as shortness of breath.

Exercise-induced asthma may or may not involve underlying chronic asthma. According to the American College of Allergy, Asthma & Immunology, as many as 90% of people with asthma also have EIA, but not everyone with EIA has asthma.

Understanding what triggers exercise-induced asthma can better enable you to manage your symptoms so you can stay well and physically active.

Exercise-Induced Asthma Symptoms

The most common symptoms of exercise-induced asthma are characteristic of all forms of asthma:

• Shortness of breath
• Chest tightness
• Chronic cough
• Wheezing

In EIA, these symptoms begin during exercise and may become worse 10 to 15 minutes after the activity is stopped. Within 20 to 30 minutes of rest, symptoms usually resolve.

Causes

Asthma attacks occur when the muscles of the airways tighten, causing them to narrow—a process called bronchoconstriction that is characteristic of chronic asthma. For people with EIA, bronchoconstriction has to do with the temperature of the air inhaled during during physical exertion.

When you exercise, you tend to take in air more quickly through your mouth than usual. This air is usually colder and drier than air inhaled through the nose, which regulates the temperature and humidity of air before it makes its way to the lungs.

In those who have chronic asthma and exercise-induced bronchoconstriction, those symptoms may be even more readily induced or severe.

Other factors that can trigger EIA and increase the severity of symptoms include exposure to these conditions while exercising:

• Cold weather
• Air pollution and airborne irritants (e.g., smoke, strong fumes)
• High pollen counts
• A recent cold or asthma episode

Exercise-induced asthma occurs in approximately 5% to 20% of the general population, but the prevalence is higher in children and elite athletes.

Diagnosis

If you have already been diagnosed with asthma and begin to show signs of bronchoconstriction after physical activity, your healthcare provider may diagnose EIA based on your symptoms.

However, because exercise-induced asthma symptoms are similar to those of many other disorders, your practitioner may require other diagnostic evaluations including a complete history, physical examination, and results of pulmonary function testing. The same is true if you are presenting with these symptoms and do not have an asthma diagnosis.

Your healthcare provider may use spirometry, a lung function test, to evaluate your breathing before and again after you exercise. For instance, you might be asked to spend time on a treadmill or stationary bicycle while being supervised by a medical professional or technician.

Before you begin, healthcare providers will record your forced expiratory volume (FEV1), the measure of how much air you can exhale during a forced breath. You'll then exercise until you reach 85% of your expected maximum heart rate. Immediately after you stop exercising, your practitioner will measure your FEV1 again.

If it has dropped 10% or more, you're likely to be diagnosed with EIA. The test may be repeated to ensure accurate results.

Before confirming a diagnosis of exercise-induced bronchoconstriction, your healthcare provider may perform additional tests to rule out other causes of your symptoms, such as:

• Gastroesophageal reflux disease
• Rhinosinusitis
• Vocal cord dysfunction
• Obstructive sleep apnea
• Obesity
• Heart failure
• Coronary artery disease

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Treatment

EIA is best managed when you work with your healthcare provider to identify, eliminate, and control triggers.

For instance, in some cases, you might lower the risk of an episode if you work out indoors or wear a mouth covering when exercising outside in colder weather.

Limiting your exposure to pollution and allergens while you exercise can also help.

Medication

Medication may also be required to manage your symptoms. You and your healthcare provider will work together to choose the most effective preventive and acute treatment options, which will mainly be based on whether or not you have a chronic asthma diagnosis along with EIA.

There are three types of medications that are commonly used to prevent or treat EIA symptoms:

• Short-acting beta-agonists (SABAs): This type of bronchodilator is often called a rescue inhaler. It delivers medication into the airways to quickly open them and stop symptoms if they occur during or after physical activity. Using a SABA 10 to 15 minutes before exercise can help prevent symptoms from occurring during activity as well. The effects should last for up to four hours.
• Long-acting beta-agonists (LABAs): This type of bronchodilator inhaler needs to be used 30 to 60 minutes before activity. The medication is typically used to prevent exercise-induced asthma for 10 to 12 hours, but it doesn't offer quick relief, so it won't stop symptoms once they start. It should be used no more than once per 12 hours.
• Mast cell stabilizers: These drugs prevent blood cells in the immune system called mast cells from releasing histamine and other substances that can trigger asthmatic reactions. The medications should be taken 15 to 20 minutes before exercise to prevent EIA, but they will not relieve symptoms once they have begun.

Staying Active

While activity is the very thing that triggers exercise-induced asthma, poor physical condition can also increase your incidence of asthma attacks.

Finding safe ways to continue staying physically active can enable you to build muscle strength, boost cardiovascular health, and improve your lung function. These benefits can protect you against future exacerbations, as well as improve your overall health.

You might consider seeking the advice of a personal trainer with experience working with people with asthma so that you can learn activities that can both advance your fitness and keep your EIA under control.

Finally, don't underestimate the importance of warming up. Engaging in about 15 minutes of gradually increasing exercise before an intense exercise session can help prevent or reduce EIA symptoms.

In Case of an Asthma Attack

If asthma attack occurs during physical activity, it's important to act quickly to halt the episode. 

1. Stop all activity and try to stay calm.
2. Get away from or remove any obvious triggers (smoke, dust, cold air).
3. If you have a rescue inhaler, take it.
4. Try to slow or control any erratic breathing.
5. If the symptoms continue, get medical attention quickly.

Asthma symptoms generally come on slowly and increase over time, and they can actually get worse once exercise stops. But with medication and patience, the episode should pass.

A Word From Verywell

Exercise-induced asthma doesn't have to keep you from physical activity. In fact, exercise is an important part of your management plan. Many successful athletes with this condition continue to play sports by learning how to manage their condition. By avoiding triggers when possible and using medication when necessary, you can remain healthy and physically fit.