Expert Q&A: Exercising with Asthma
Exercise is a common trigger for asthma. But with proper precautions and pre-treatments, all but the most severe asthmatics should be able to exercise regularly and safely. National Jewish asthma expert Sally Wenzel , MD, answers common questions about exercise-induced asthma.
Q: How can I know if I have exercise-induced asthma?
A: For some individuals, exercise-induced asthma occurs within three to eight minutes of starting activity or exercise. For many, exercise-induced asthma occurs after stopping exercise. While everybody gets a little winded when they exercise, people with exercise-induced asthma also commonly experience a hacking cough, wheezing, and/or chest tightness. It is important, although not necessarily easy, to recognize the difference between poor conditioning and exercise-induced asthma. In well-conditioned athletes, symptoms of exercise-induced asthma may occur only with the most vigorous activity or exercise.
Q: How is exercise-induced asthma treated?
A: Fortunately, there is a simple and effective way of treating exercise-induced asthma. By using a prescribed inhaled "pre-treatment," people with asthma should be able to participate safely and successfully in exercise, sports and physical activities.
There are a number of medicines that can lead to complete control of exercise-induced asthma. We usually like to begin with the tried and true beta-agonist (i.e. Albuterol) as an exercise pre-treatment. However, this may not be enough for complete control.
Some people with exercise-induced asthma respond well to other medications, such as cromolyn sodium (intal®) or nedocromil sodium (tilade®). In all cases, work with your healthcare provider to decide the treatment that is best for you.
Q: What role do routine inhaled steroids play in controlling exercise-induced asthma?
A: Inhaled steroids and other anti-inflammatory asthma medications play an important role. Controlling underlying inflammation reduces lung twitchiness in asthma, which makes any asthma trigger, including exercise, less of a problem.
Q: What sports are best for people with exercise-induced asthma?
A: Sports or activities with intermittent periods of activity are least likely to cause asthma symptoms. Activity followed by brief rest periods can allow the person to regain control of their breathing. Sports such as baseball, softball, volleyball, tennis, golf and some track and field events all have intermittent rest periods. However, sports that require continuous activity like swimming, cycling, distance running and soccer also can be enjoyed by people with exercise-induced asthma. It is important to realize that people with exercise-induced asthma can participate in any sport.
Q: Is it true that structured exercise can actually be beneficial for asthmatics?
A: Absolutely! With asthma controlled, a structured exercise program will improve conditioning and help weight loss. This, in turn, reduces cardiopulmonary work necessary for any activity, making asthma more difficult to trigger. Exercise to improve your asthma, and live longer and better as an added bonus.
Q: Why do some asthmatics have more symptoms with cold weather?
A: Cooling and drying of the airway lining triggers bronchospasm when the lung airways are twitchy due to asthma. In fact, exercise-induced bronchospasm probably results from rapid breathing through the mouth, which causes the moisture on the lining of the lung airways to evaporate, leading to evaporative cooling.
Q: How do you suggest we handle the fear that parents have of their children participating in exercise programs?
A: This is a surprisingly common concern since physical exertion is one of the most common asthma triggers. First, the asthma must be controlled so that it does not trigger with exercise. Once that is achieved, then one can build confidence as exercise conditioning and tolerance is gradually increased. The main message is that, for all except the rare severe asthmatic, you or your children should be able to completely control asthma while participating in the sport of your choice.
