You've just finished a great workout when you start coughing. You have a hard time breathing, and your chest feels tight. Did you push yourself too hard? Maybe. But you're not out of shape. At least, you didn't think so. But this isn't the first time this has happened after you've exercised.
Sound familiar? If so, then you may be part of roughly 15% of the population, including top athletes like Dennis Rodman, who experience exercise-induced
asthma
(EIA), says William Storms, M.D., an allergist with Asthma and Allergy Associates in Colorado Springs, CO.
Simply put, EIA is asthma that's triggered by exercise. It most commonly strikes 10 to 15 minutes after a workout or during a workout session, particularly at the beginning of more intense exercise.
Symptoms include:
- wheezing
- coughing
- tightness in the chest
- shortness of breath
Other symptoms, although somewhat more rare, may include stomach cramps, chest pain, nausea, or headaches, Storms says.
EIA affects men and women of all ages and fitness levels and typically occurs in people who suffer from day-to-day asthma. According to the American Lung Association, 14.6 million Americans suffer from asthma, making asthma the seventh most common chronic condition in America.
"Almost everyone who has asthma is at risk of suffering (EIA)," says Sally Wenzel, M.D., a staff physician with the National Jewish Medical and Research Center in Denver, Colorado. This is one reason many asthmatics choose not to exercise, which is unfortunate because doctors actually prescribe exercise for asthma patients. Physically fit asthmatics, after all, usually have fewer attacks and need less medication, Wenzel says.
Ironically, EIA can even affect people who do not suffer from daily bouts of asthma. Some experts estimate that approximately two-thirds of EIA sufferers have asthma; the other one-third are people who have hay fever but no other asthma symptoms.
For reasons that are somewhat unclear, exercise can trigger an asthma attack. This doesn't mean, though, that EIA will strike every time you exercise.
According to Storms, changes in temperature and moisture in the airways may play a part in EIA. Rapid breathing due to exercise may cool and dry the airways, thus causing the muscles around the airways to tighten which in turn leads to asthma symptoms.
Symptoms often increase when air pollutants, pollen, or cold, dry air is present. That's why EIA is more common in cold weather sports like speed skating, figure skating, and cross-country skiing.
The symptoms generally subside within 20 minutes. Then for durations up to three hours later, often called the
refractory period
, people may experience fewer asthmatic symptoms if they resume exercise, Wenzel says.
Unfortunately, EIA is often overlooked and misdiagnosed, which can lead to bigger health problems down the road. "If people don't get the condition diagnosed, they either won't exercise or they stop exercising," Storms says, adding that a good diagnosis involves a breathing test usually performed after exercising. "Because they're sedentary, their health deteriorates."
Treatment options for EIA are numerous. The best option varies from person to person and may include medications that are either inhaled or swallowed. Inhaled beta-agonists are perhaps the most common treatment, Wenzel says, because taken before exercising, they relax the muscles in the airways to help prevent constriction.
Because a large variety of treatments are available, EIA shouldn't prohibit anybody from being active. "Everybody should be able to participate in exercise at any level they want," Storms says.
Take, for example, statistics from the National Jewish Medical and Research Center which reveal that 67 of the 597 athletes on the 1984 U.S. Olympic team suffered from EIA. Athletes with EIA won 41 of the medals that year.
The key to preventing or reducing the frequency of EIA is to exercise sensibly. Following are some general guidelines; talk to your doctor about what measures would work best for you.
Use an inhaler 15 minutes before exercising if your doctor recommends it. Carry it with you while you're exercising and use it if you experience asthma symptoms. If you don't have medication with you when you experience EIA, move into the warmest, most humid place you can find. "This helps heat and moisten the airways," Wenzel says.
Using an inhaler can be tricky, says Sally Wenzel, M.D., a staff physician with the National Jewish Medical and Research Center in Denver, Colorado.
Some common mistakes include inhaling too early or too late and breathing in too quickly. When you breathe in too fast, the spray usually ends up in the back of your throat which means you won't receive the full benefits of the inhaler. "When you spray it in the back of your throat," Wenzel says, "it will be absorbed into the bloodstream and may cause your heart rate to go up."
To avoid those mistakes, follow this advice from Wenzel:
- Practice breathing first. Without depressing the canister, hold the inhaler about two finger breadths from your mouth. Take an average size breath and blow out.
- Now as you inhale slowly, depress the canister and activate the inhaler.
- Continue inhaling for three to five seconds after you activate the inhaler.
- Hold your breath for five to ten seconds.
- Release your breath naturally.
- Wait 20 to 30 seconds before repeating the process.
Consider adding swimming to your exercise program. Because the air is warmer and moister when swimming, there's less chance of an EIA attack. The only water sport that people susceptible to EIA should avoid is scuba diving, Storms says. The pressurized air that you breathe increases the risk of an asthma attack.
Wear a face mask or scarf over your nose and mouth when exercising in cold weather, Wenzel says. This warms the air before it reaches your lungs.
Breathe through your nose. Although this may be difficult as the intensity of your workout increases, breathing through your nose helps warm the air before it reaches your airways.
Induce a refractory period. Thirty to 60 minutes before exercising, do a short warm-up where you break a sweat. "This shouldn't be intense," Wenzel says. "Just enough to get your heart rate and breathing up slightly." Then take a break. When you're ready to exercise 30 to 60 minutes later, you may be less susceptible to suffering an asthma attack.
If you are sensitive to pollen, exercise indoors when pollen counts are high. If you have to exercise outside, talk to your doctor about adjusting your medication to manage your asthma, Storms says.
Avoid exercising when you have a cold or the flu or when your daily asthma isn't under control.
Watch the intensity of your workouts. "The more intense the workout," Storms says, "the more severe the symptoms tend to be." Activities like tennis with periodic breaks of exertion may be less likely to cause EIA than endurance sports like running or cycling.
To prevent EIA after working out, cool down with 10 to 15 minutes of lighter activity like walking slowly and stretching.
