Focus on Exercise-Induced Asthma


YOUR ALLERGY PARTNERS

Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio, MD; Nanneth T. Tiu, MD – a group of expert Filipino ALLERGISTS bond together as the H & L Allergy Team, whose aim is to give advice, to help readers understand and find relief in dealing with common allergic disorders.

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Do you have cough, wheezing, chest tightness, or shortness of breath during or after sports or exercise? If you do, you may be experiencing exercise-induced asthma (EIA)!

Exercise-induced bronchoconstriction (EIB) is the preferred term for what was known for many years as exercise-induced asthma. It occurs in 5 percent to 20 percent of the general population. Atopy is strongly associated with exercise- induced asthma (EIA), and up to 40 percent of patients with allergic rhinitis have EIA.

EIA has been recognized since the first Olympic Games. Many elite (30-70 percent) and world-class athletes have EIB – including Olympic medal winners in sports like cross country skiing, figure skating and ice hockey. EIB didn’t hold them back, and it shouldn’t hold you back either!

Symptoms:

• Develop when airways narrow as a result of physical activity.
• Clinically, EIA is usually preceded by 3 to 8 minutes of exercise. Peak symptoms usually occur 8 to 15 minutes after exercise is complete and then begin to remit spontaneously; recovery occurs within 60 minutes.
• Shortness of breath a few minutes after starting to exercise/ play sport
• Tight feeling in chest while playing a sport or exercising
• Stopping exercise/sport/activity because you feel unwell
• Wheezing and/or coughing Causes/triggers:
• Environmental factors may contribute to EIB in some cases.
• When you are working out or competing in a gym, perfume, cleaners, paint, and new equipment or carpets could also be triggers.

Types of air (cold or dry air)

While it was thought for years that breathing cold air makes EIB worse, more recent studies indicate that the dryness of the air, rather than the temperature, is more likely the trigger. Cold air typically contains less moisture than warm air, and quickly breathing dry air dehydrates the bronchial tubes, causing them to narrow and restrict airflow.

Types of sports and activities:

The activities that are most likely to cause EIB symptoms require constant activity or are done in cold weather. These include soccer, basketball, long-distance running, ice hockey, ice skating and cross-country skiing.

The activities that are least likely to cause EIB symptoms include walking, hiking and recreational biking, or sports requiring only short bursts of activity. These include volleyball, gymnastics, baseball, wrestling, golf, swimming, football, and short-distance track and field sports. Some swimming events can demand constant activity, but the warmth and humidity from the water make it easier for people with EIB to breathe.

Diagnosis

To make a diagnosis, your doctor will take a thorough history that includes:

• Family history of asthma or other breathing difficulties
• Details of your physical activity: what type, where and how often you exercise
• Any presence of other conditions, such as upper-airway problems, that might play a role in your difficulties with exercise.

Diagnostic tests

To check how exercise affects your breathing, your doctor may measure your breathing before, during and after you run on a treadmill or ride an exercise bike. During the test you will breathe into a tube that connects to a spirometer, a device that measures the volume of air being inhaled and exhaled.

Treatment and management

• An allergist will customize a treatment plan that allows you to get back to the exercise you love, and feel better while doing it.
• Medicines used to treat asthma are also used to prevent and treat EIB symptoms. They are usually taken through an inhaler, though some are available in tablet form.
• Short-acting inhaled beta2-agonists (bronchodilators) stop symptoms right away. They may be taken 15 to 30 minutes before vigorous exercise and generally prevent symptoms for two to four hours. These medications are extremely effective in treating or preventing EIB symptoms, so if symptoms do not improve, let your allergist know. Long-term control asthma medicines are taken daily to prevent symptoms and attacks.
• Inhaled corticosteroids. These are the most commonly prescribed long-term asthma medications. They help to relieve narrowing and inflammation of the bronchial tubes. It may take two to four weeks before these drugs reach their maximum effect.
• Long-acting inhaled beta2-agonists (bronchodilators). Taken 30 to 60 minutes before exercise, these medications help prevent symptoms for 10 to 12 hours. They should be used only once within a 12-hour period, and they should be taken only in combination with an inhaled corticosteroid.
• Montelukast, a leukotriene receptor inhibitor, is also approved for the treatment of exercise-induced asthma symptoms. Taken once daily, this medication can help prevent symptoms that accompany exercise.
• Elite athletes should check with the governing bodies of their sport about the medicines they are allowed to take to relieve their EIB or asthma symptoms. Another resource is the Prohibited List, published by the World Anti- Doping Agency. Some medications (including beta2- agonists) are considered performance- enhancing drugs and cannot be used by athletes in competition unless a Therapeutic Use Exemption is granted for medical need.

Other suggestions for relieving symptoms of EIB include:

• Warm up with gentle exercises for about 15 minutes before you start more intense physical activity.
• Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.
• Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.
• Avoid triggers by making changes to your exercise routine.
• See an allergist to discuss prescription medications, which may be more effective than over-the-counter treatments.


References
• ACAAI (American College of Allergy, Asthma & Immunology)
• AAFA (Asthma and Allergy Foundation of America)

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