What Is Bronchoconstriction?

Sports-playing boy using asthma inhaler
Sports-playing boy using asthma inhaler. Getty Images/Gary Ombler/Dorling Kindersley
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Bronchoconstriction is the tightening of smooth muscles that surround your airways, which obstructs the movement of air into and out of your lungs. The condition commonly affects those who have been diagnosed with different types of asthma, but you might also be at risk if you have other lung diseases. Bronchoconstriction can lead to an asthma attack and typically needs to be treated with inhaled medication to relieve symptoms or to prevent future occurrences. In addition to prophylactic medication, you can reduce your chances of bronchoconstriction by avoiding situations or conditions that put you at risk.

Types

Airway constriction is most often associated with two types of asthma:

  1. Exercise-induced asthma (EIA): EIA is also referred to as exercise-induced bronchoconstriction because physical activity directly results in the narrowing of the bronchi and bronchioles. During or immediately following exercise, those with EIA suffer symptoms of bronchoconstriction.
  2. Allergic asthma: For some people, seemingly harmless materials or elements of nature stimulate the immune system, causing the release of chemicals that make the airways constrict. Usually, you will not have symptoms of bronchoconstriction the first time you're exposed to an allergen. Problems usually occur at the second exposure or later.

Symptoms of Bronchoconstriction

As the airways that carry air to and from the lung constrict, several breathing-related problems can occur. Some may be minor and easy to overcome. However, if the symptoms do not resolve on their own or with medication, they can lead to serious complications.

Symptoms are similar to typical asthma symptoms.

Shortness of Breath

With constricted airways, it becomes difficult to get enough air into your lungs for normal body functions. The brain sends out a signal that you need to breathe faster to get more air. Shortness of breath is characterized by short rapid inhalations as you try to get more air—but as long as your airway is narrowed, the lack of oxygen will continue. If shortness of breath continues, it can lead to oxygen deprivation, which can cause confusion or loss of consciousness.

Chest Tightness

Chest tightness is the feeling that your chest has a band around it and you can’t push air in and out of your lungs. It can begin at the same time as other symptoms or occur after they’ve started. This sensation and the feeling that you can't control your breathing can cause anxiety that worsens your symptoms.

Chronic Cough

A chronic cough is a cough that can't be soothed. In the case of bronchoconstriction, cough receptors are stimulated as the airway is constricted, although why this occurs is not well understood. The result is a cough that is dry and "non-productive,” which means there is no phlegm or mucus in your cough. Instead, it sounds raspy, dry, and wheezy. 

Wheezing

Wheezing is the high-pitched sound that you make when you inhale or exhale through a narrowed airway. Wheezing after physical activity may be the first sign of asthma, especially in children. While it is not a life-threatening symptom, it can alert you to the fact that you are at risk for asthma attacks and should discuss the possibility of allergic asthma or EIA with your doctor.

Causes

The process of bronchoconstriction starts when something triggers the muscles along the airways to tighten. This squeezes the bronchi and bronchioles so your airway is blocked.

These triggers are associated with the two types of bronchoconstriction: EIA and allergic asthma. However, you don't have to be asthmatic to be susceptible to these triggers and suffer from bronchoconstriction. Many others, including those with chronic bronchitis and other types of chronic obstructive pulmonary disease (COPD), are also at risk of bronchoconstriction.

Low air temperature and exposure to irritants are the most likely triggers for all cases of bronchoconstriction

Inhaling Cold Air

Exercise-induced bronchoconstriction occurs in people who are sensitive to cool air traveling thought their airways. When you exercise, you breathe in through your mouth as you try to pull in more oxygen to keep up with the physical exertion. When you take air in through your mouth, it's cooler than the air you breathe in through the nose. If you're exercising in a cold environment (especially outdoors in the winter), the low-temperature air may trigger a reaction that causes the muscles around your airways to contract.

Symptoms of bronchoconstriction may occur shortly after starting a workout and may become worse 10 to 15 minutes after stopping exercise. They will usually go away within 20 to 30 minutes of stopping the activity.

Research shows that people susceptible to cold-weather muscle tightening of the airways include those with lung disease as well as healthy people with no known lung ailments.

Exposure to Allergens and Irritants

For some people, seemingly harmless materials or elements of nature are seen by their immune systems as foreign and dangerous. Exposure to these elements produces antibodies called Immunoglobulin E (IgE), which release chemicals (such as histamine) that cause bronchial constriction and irritation that blocks normal airflow.

Common asthma triggers include:

  • Cockroaches
  • Dust mites  
  • Mold
  • Pets
  • Pollen

Irritants such as smoke and air pollutants can also trigger an asthma attack with constriction of the airways.

Bronchoconstriction may also occur in cystic fibrosis patients. In these cases, the narrowing of airways is caused when certain types of inhaled antibiotics are administered in an effort to help manage the disease. The risk is highest for those with a family history of asthma.

Diagnosis

The initial diagnosis of bronchoconstriction is based on self-reported symptoms. Your doctor will investigate to determine what triggers the constriction. The evaluation will include a complete history, physical examination, and pulmonary function testing.

An EIA diagnosis usually requires an exercise test. Your doctor will use spirometry, to measure your lung function before and after exercise. The test may include checking your tolerance of cold air.

To determine whether bronchoconstriction is caused by an allergen, you will need to undergo allergy testing. These tests may include skin tests in which common allergens are placed on or just under the top layer of your skin to see if you have a response. Blood tests may also be done to see how your immune system reacts when you're exposed to possible allergens.

Treatment

The first step is to treating bronchoconstriction is understanding what triggers your asthma and avoiding those triggers. While this sounds easy, it can be challenging. Many times you need to act like a detective, record your symptoms, and see which conditions lead to breathing problems.

Diet can also impact bronchoconstriction. A high intake of sodium has been associated with bronchoconstriction. Meanwhile, high doses of omega-3 fish oils may decrease the risk. Thus, watching your sodium and supplementing with omega-3s or getting more in your natural diet may limit some symptoms.

Medication

When an attack does occur, rescue inhalers are the first medication used to treat bronchoconstriction. Using the inhalers, you breathe the medications into your airways. Following a bronchoconstriction episode, your doctor may prescribe an inhaler that you can use in case of future attacks:

Short-acting beta agonists (SABAs): SABAs such as albuterol can ease symptoms and protect against future episodes for about four to six hours.

Long-acting beta agonists (LABAs): LABAs such as Serevent (salmeterol) lasts up to 12 hours.

SABAs and LABAs relax the smooth muscles that line the airways, allowing them to open again so breathing can return to normal and symptoms will cease. In addition to easing symptoms during an attack, these medications can prevent exercised-induced bronchoconstriction from occurring.

SABAs and LABAs do not decrease underlying inflammation, however. If needed, doctors may also prescribe inhaled steroids, which are more effective anti-inflammatory medications.

In addition to these common treatments, other medical approaches that might be used include: leukotriene receptor antagonists, ipratropium, and mast cell stabilizers

Coping

If you're at risk for asthma, always have your rescue inhaler handy. This can be particularly important for EIA since bronchoconstriction can be prevented by using your inhaler before activity.

It is also important that you have an asthma action plan that includes avoiding possible triggers such as cold-weather activity and common allergens. If you're an athlete who doesn't want to stop enjoying exercise, you might consider replacing endurance sports with activities that require shorter bursts of exercise, which may help you avoid bronchoconstriction.

A Word From Verywell

There are rare instances in which bronchoconstriction or complications related to treatment for the condition can cause serious medical complications or a fatality. In most instances, however, these episodes can be managed with proper medication. First, you need to be sure you have a rescue inhaler on hand. Anytime you suffer wheezing, shortness of breath, or chest tightness, discuss them with your doctor. If these symptoms show you are at risk for future attacks of bronchoconstriction, you can get a prescription for an inhaler that will protect you in case you have another incident.

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