What Is Exercise-Induced Asthma?

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Exercise-induced asthma (EIA), also known as exercise-induced  bronchoconstriction (EIB), is a type of asthma which is triggered by physical activity. People with exercise-induced bronchoconstriction typically experience asthma symptoms only when they play sports or workout.

EIA occurs in approximately 5% to 20% of the general population, but the prevalence is higher in children and is extremely common among elite athletes. Understanding what triggers EIA can better enable you to manage your symptoms, so you don't have to stop exercising if you suffer from asthma.

Exercise-Induced Asthma Symptoms

Asthma causes inflammation and sensitivity of the small airways of the lungs. Symptoms of exercise or sports-induced asthma vary from person to person, but the most common symptoms include:

These symptoms begin during exercise but may become worse 10 to 15 minutes after stopping physical activity. Within 20 to 30 minutes of your exercise session ending, these problems will usually go away. Cold weather often increases the frequency and severity of symptoms.

Causes

Asthma attacks occur when the muscles around your airways tighten, causing a narrowing of the airways, known as bronchoconstriction. A complex combination of genetics, environmental factors, and lifestyle choices seem to put different people at risk for these attacks.

In some people, physical exertion causes these attacks because they're sensitive to the temperature of inhaled air. Whenever you exercise, you tend to take in more air quickly through your mouth. The air you take in through the mouth is a lower temperature than air you take in through the nose during regular breathing. For those with EIA, the cooler air isn't well tolerated. It results in the airways constricting, leading to asthmatic symptoms: coughing, wheezing, and difficulty breathing.

Besides cooler temperatures, other factors that trigger EIA include exposure to these conditions while exercising:

To learn how to overcome exercise-induced asthma, you need to identify the conditions that trigger your attacks. In some cases, you might lower the risk of an asthma attack if you workout indoors or wear a mouth covering when exercising out outdoors in colder weather. Limiting your exposure to pollution and allergens while you exercise can also improve your chances of avoiding an asthma attack.

Poorer physical condition can also increase your your incidence of asthma attacks. Finding ways to continue working out without succumbing to asthma can enable you to build muscle strength, improve lung function, and boost cardiovascular health. These benefits can protect you against future asthma attacks.

Another key to enjoy playing sports with reduced asthma risks is to perform a thorough warm-up before workouts. About 15 minutes of gradually increasing exercise before an intense workout is important for someone with asthma.

Diagnosis

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

However, because EIA symptoms are similar to the symptoms of many other disorders, your doctor may require other diagnostic evaluations including a complete history, physical examination, and results of pulmonary function testing.

Tests may include your doctor using 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 doctor or technician. Before you begin, doctors will measure your FEV1 (forced expiratory volume)—this is 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 doctor 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.

Some doctors may also recommend a bronchoprovocation challenge test in which you inhale saline or another substance, and doctors measure whether or how much your airways constrict. Studies show that these tests can offer results as accurate as exercise tests.

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

Treatment

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

Choose the most effective preventative and maintenance medications, and have an asthma emergency plan.

While avoiding triggers may significantly reduce the frequency or severity of asthma attacks, medication may also be required to manage your symptoms. There are three types of medications that are commonly use to prevent or treat EIA symptoms:

  • Short-acting bronchodilator: An inhaler delivers medication into the airways, opening the bronchi and bronchioles, Using an inhaled short-acting bronchodilator 10 to 15 minutes before exercise helps prevent symptoms from occurring during activity. The medication should last for up to four hours. You can also use the inhaler to stop symptoms if they occur during or after physical activity.
  • Long-acting bronchodilator: This inhaler needs to be used 30 to 60 minutes before activity and only once within a 12-hour period. The medication is typically used to prevent EIA for 10 to 12 hours, but it doesn't offer quick relief, so it won't stop symptoms once they start.
  • 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 such as Alocril (nedocromil) should be taken 15 to 20 minutes before exercise to prevent EIA, but they will not relieve symptoms once they have begun.

A Word From Verywell

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

When an asthma attack does occur, 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 temperatures).
  3. If you have prescription medication, take it.
  4. Try to slow or control any erratic breathing.
  5. If the symptoms continue, get medical attention quickly.

The onset of 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. If ever you feel that your breathing isn't improving after treatment, seek emergency help immediately.

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