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This information was reviewed and approved by David Tinkelman, MD (3/31/2012).

Question: I feel tired and cough a lot when I exercise. Am I just out of shape or could this be exercise-induced asthma?

Answer: It is important, although not necessarily easy, to identify if this is poor conditioning or exercise-induced asthma. While everybody gets a little winded when they exercise, people with exercise-induced asthma (EIA) also commonly experience a hacking cough, wheeze and chest tightness. Individuals with exercise-induced asthma typically experience symptoms within 5-10 minutes of exercising, but some people have asthma symptoms only when they stop exercising.

To learn if you have exercise-induced asthma, talk to your healthcare provider about your symptoms. Your doctor will ask you questions and do a physical exam. In addition, your doctor may order a combined breathing and exercise test, called an exercise challenge. During an exercise challenge, you will walk or run on a treadmill or ride an exercise bicycle. You will be asked to do a breathing test (spirometry) before and after exercise to monitor changes in your breathing. This test can specifically answer the question.


Question: Why does exercise trigger asthma? 

Answer:  When breathing at rest, we tend to breathe through our nose. This allows the nasal passages to warm and humidify the air we breathe in before it reaches the lungs. During exercise, we tend to breathe more quickly and through our mouth. This results in air that is cooler and drier when it reaches the airways. In people with sensitive airways, such as those with asthma, this can trigger bronchospasm and lead to coughing, wheezing and chest tightness. 


Question: If my doctor and I suspect exercise-induced asthma, do I need to do a spirometry test or can I just use my peak flow meter?

Answer: If your doctor orders an exercise challenge test, you will be asked to do a breathing test before and after you exercise. Your breathing can be checked by performing a spirometry test or blowing into a peak flow meter. While spirometry results provide more information than using a peak flow meter, a diagnosis of exercise-induced asthma can often be made based on the change in peak flow numbers following exercise.


Question: How is exercise-induced asthma treated? 

Answer: Your healthcare provider may prescribe a "pre-treatment" to use 10-15 minutes before exercise. A pre-treatment is a medicine you inhale that prevents asthma symptoms during and after exercise.

In most cases, a beta-agonist medicine that quickly opens the airways is used for pre-treatment. Examples of this medicine include: Proventil®, Proventil HFA®, Ventolin® (albuterol); Maxair® (pirbuterol) and Xopenex® (levalbuterol). Other medicines, such as Intal® (cromolyn sodium) or Tilade® (nedocromil sodium) may be prescribed. Some people need to take long-term control medication every day for complete control of exercise-induced asthma.


Question:  What sports are best for someone with exercise-induced asthma? 

Answer: Sports or activities with bursts of activity followed by brief rest periods are least likely to cause asthma symptoms. Intermittent periods of rest can allow people with asthma to regain control of their breathing. Baseball, softball, volleyball, tennis, golf and some track and field events are examples of sports that allow for brief periods of rest. However, sports that require continuous activity such as long-distance running, basketball and cycling can also be enjoyed by people with exercise-induced asthma. It is important to use your exercise pre-treatment as directed, include a good warm-up and cool-down period and monitor asthma symptoms with a peak flow meter.


Question: Can structured exercise actually benefit asthmatics? 

Answer: With asthma controlled, structured exercise will improve conditioning, reduce weight, and thereby reduce cardiopulmonary work for any daily activity; thus, asthma becomes more difficult to trigger. This may not seem significant, but I see many asthmatic children who are deconditioned due to inadequately controlled asthma and lifestyle. Their asthma can be triggered by going up a flight of stairs in school between classes, often each day. Exercise for asthma, and live longer and better as a bonus. 


Question: How can I avoid the triggers for exercise-induced asthma? 

Answer: Almost all asthmatics have some degree of exercise-induced asthma. The differences between them are the amount of exercise that is required before someone has difficulty. Someone who is quite stable might not experience any difficulty at all unless extremely challenged. For those experiencing an infection with wheezing, it might take very little activity at all to cause difficulty. The main "trigger" for exercise-induced asthma is exercise. However, other factors (infection, allergy, changes in the weather) can make someone more sensitive to exercise. One way to deal with exercise-induced asthma is to pre-treat with a beta agonist right before activity.


Question: Is outdoor exercise in reasonable weather good for the asthmatic if there is air pollution? Should asthmatics work on cardiovascular health year-round? 

Answer: Exercise outdoors for asthmatics is very good, despite the pollution or allergen exposure tradeoffs. Thus, the asthma needs to be controlled well enough to handle these exposures. Good cardiopulmonary conditioning for asthmatics is great and helpful for daily function. Note that this is also true for general good health.

Read more about cold-weather activities and asthma.


Question: What is the role of routine inhaled steroids in the control of exercise-induced asthma? 

Answer: Inhaled steroids play an important role. Controlling underlying inflammation reduces lung twitchiness in asthma, which males any asthma trigger less of a problem, including exercise. 


Question: Are our maintenance asthma medications supposed to control our symptoms so well that we don't need to pre-treat to avoid exercise-induced asthma? 

Answer: Maintenance medications are supposed to help. Often, maintenance medications alone are not enough to provide complete control of exercise-induced asthma, especially the more vigorous the activity, or when exposed to pollution or allergens. 


Question: Is it a reasonable goal for asthmatics to experience no symptoms and participate in all activities they desire? 

Answer: Yes. For most asthmatics, this is obtainable. A recent Asthma in America survey showed that most asthmatics were settling for substantially less. They shouldn't.

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