Is exercise a risk for asthma?

May 3, 2018

A man water skiing in a crystal blue lake.What do soccer great David Beckham, track and field star Jackie Joyner-Kersee and daredevil diver Greg Louganis have in common besides winning Olympic medals? They all suffer from what used to be called exercise-induced asthma. Used to be.

Now it’s more correctly called exercise-induced bronchoconstriction, or EIB.

“Exercise is not a risk factor for asthma; rather it is a trigger of bronchoconstriction,” said Dr. Robert Janata, a pulmonologist and Medical Director of Lung and Respiratory Care at UCHealth Pulmonology Clinic at Longs Peak Hospital in Longmont.

EIB is not asthma – although many people with asthma also suffer from EIB. It is the acute narrowing of the airway that occurs as a result of exercise. But it also occurs in those who do not have asthma. The difference between the two afflictions was clarified in 2010, Janata said. One difference is that EIB rarely occurs at night or when the patient is at rest. The confusion comes because the symptoms are so similar – coughing, wheezing and dyspnea (shortness of breath).

EIB is not uncommon – it affects from 5 to 20 percent of the general population. Asthma affects more than 300 million people worldwide, and about 90 percent of those also have EIB, he said.

A photo of Dr. Robert Janata
Dr. Robert Janata

EIB tends to show up more among elite athletes –in about 18 percent of swimmers, 16 percent of cyclers and 12 percent of triathletes. EIB also afflicts about 20 to 35 percent of hockey players and ice skaters, likely triggered by a large volume of relatively cool, dry air and emissions from cleaning equipment.

Swimmers who experience a longer duration of exposure to chloramines (more than 100 hours) also show a higher prevalence of EIB. (Discontinuation of swimming resulted in decreased EIB.)

Other triggers include pollution, pollen and other irritants, as well as general air quality, he said, and noted that ozone also plays a role. “Higher levels of ambient ozone, emissions and particulate matter from traffic have been shown to enhance EIB response in asthmatic children,” he said.

He cites a case study in his presentations on EIB. The subject is a 15-year-old boy who loves sports but can’t keep up with the other players. Shortly after he embarks on an activity, he becomes winded and begins coughing. After taking an exercise test, his lung function had decreased by 25 percent, Janata said.

That’s typical of EIB.

“Bronchoconstriction typically begins several minutes after exercise, and peaks in about 10 to 15 minutes,” he said. Typical symptoms include: shortness of breath, chest tightness, coughing and wheezing.

The good news is, therapy can help prevent symptoms induced by exercise and even enhance overall asthma control, Janata said.

The most common treatment is short-acting inhalers although some patients may do well on long-lasting therapies such as inhaled steroids.

He also recommends that those who tend to experience
EIB take time to warm up prior to their activity and exercise regularly to improve their overall cardiovascular fitness.

Short-acting therapy such as Albuterol is the most effective quick-acting therapy for EIB when given 5 to 15 minutes prior to starting exercise. It can be effective for as long as 2 to 4 hours. The downside is that it may not prevent bronchoconstriction in as many as 15 to 20 percent of asthmatics, and daily use may lead to tolerance (and, thus, ineffectiveness).

When used with the case study patient, Albuterol worked well when he could use it, but it wasn’t always possible to use it before all activities. When he changed, and started to use Singulair every night before bed, it almost eliminated his need to use the Albuterol.

“Now he is able to keep up with the other kids,” Janata said.

Anyone who thinks they are suffering from EIB should consult with their primary care provider or a specialist for diagnosis and treatment, he said. After all, it didn’t stop dozens of Olympic athletes.

About the author

Linda DuVal is a freelance writer based in Colorado Springs and a regular contributor to UCHealth Today. She has written travel articles for major U.S. newspapers and national, regional and local magazines. She spent 32 years as an award-winning writer, reporter and editor for The Gazette in Colorado Springs.