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Diseases & Conditions

Exercise-Induced Asthma

(Also Called 'Exercise-Induced Asthma - Exercise')

Exercise-induced asthma is asthma that is triggered by vigorous or prolonged physical activity. Most people who have chronic asthma will experience symptoms when they exercise. However, many people without chronic asthma develop symptoms only during exertion.

During normal breathing, the air we breathe is first warmed and moistened by the nasal passages. One of the reasons that exercise-induced asthma may occur is that during exercise, people tend to breathe through the mouth, which means that they inhale colder and drier air. In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity of the inhaled air and react by contracting (or spasming), which narrows the airway. This results in symptoms of asthma, which include:

  • Coughing
  • Tightness in the chest
  • Wheezing
  • Unusual fatigue while exercising
  • Feeling short of breath while exercising

Other factors that can influence the degree of symptoms with exercise are the presence of pollens and pollutants in the air and upper respiratory infections.

The symptoms of exercise-induced asthma generally begin within five to 20 minutes after the start of physical activity, or 5-10 minutes after brief exercise has stopped. If you are experiencing any of these symptoms with physical exertion, tell your doctor.

You should not avoid exercise because of exercise-induced asthma. There are steps you can take to control the symptoms and allow you or your child to maintain normal physical activity.

Inhaled medications taken prior to exercise can control and prevent exercise-induced asthma symptoms. The preferred medications are the short-acting beta2 agonist inhalers (i.e., ProAir®, Proventil HFA®, Ventolin HFA®, Xoponex HFA®); taken 15-20 minutes before exercise, these medications can prevent the airways from contracting and can provide control of exercise-induced asthma for as long as 4 to 6 hours.

Other medications that may be used are long acting bronchodilators (LABA). These medications, salmeterol (Serevent®) and formoterol (Foradil®), are taken about 30 minutes before exercise and keep the airways open for 12 hours. Recently the Food and Drug Administration issued a warning that these medicines may increase the risk of asthma attacks in certain people, therefore they are always used in combination with an inhaled corticosteroid and are never used alone in the treatment of asthma. If you are on one of these combination medications you should still keep a short acting bronchodilator with you in case symptoms occur with exercise. If these measures fail to control exercise-induced asthma symptoms, your physician may determine that you need daily therapy to control the underlying inflammatory process that results in unstable airways. It is important to communicate with your health care provider how treatment of your exercise- induced symptoms is working.

In addition to medications, a warm-up phase before exertion and a cool-down period afterward can help prevent exercise-induced asthma. Exercise should be limited during high pollen days (if allergic) or when temperatures are extremely low and air pollution levels are high. The presence of viral upper respiratory infections can also increase symptoms, so you should restrict exercise if you have such an infection.

For people with exercise-induced asthma, some activities are better tolerated than others. Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, walking, and wrestling are generally well-tolerated. Activities that involve long periods of exertion (soccer, distance running, basketball, and field hockey), as well as cold weather sports (ice hockey, cross-country skiing, ice skating), may not be tolerated as well. However, many people with asthma are able to fully participate in these activities. Swimming, which is a strong endurance sport, is generally well-tolerated by asthmatics because it is usually performed in a warm, moist air environment. It is also an excellent activity for maintaining physical fitness.

Maintaining an active lifestyle is important for both physical and mental health. The goal of treating exercise-induced asthma is to allow full participation in sports and activities. It's important to communicate with your or your child’s health care provider when the treatment plan is not effectively controlling exercise-induced asthma. Appropriate treatment will allow you or your child to fully benefit from an exercise program.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/1/2009...#4174