Exercise-Induced Asthma

What is exercise-induced asthma?

Exercise-induced asthma happens when your airways get smaller during exercise, making it hard for you to breathe. You may have asthma symptoms like coughing, wheezing and shortness of breath during or after physical activity.

Symptoms can be worse when the air is cold and dry, or when pollution levels and pollen counts are high. Exercise-induced asthma is also called exercise-induced bronchoconstriction (EIB) or sports-induced asthma.

How common is exercise-induced asthma?

About 40% to 90% of people with asthma have symptoms during or after exercise. But it can happen even without an asthma diagnosis — up to 20% of people in the general population (who may or may not have asthma) have exercise-induced asthma symptoms.

What are the symptoms of exercise-induced asthma?

Symptoms of exercise-induced asthma include:

• Chest tightness.
• Coughing (coughing is the only symptom for some people).
• Difficulty breathing (shortness of breath). You may feel like it’s hard to push air out of your lungs.

Symptoms can range from mild to severe. They can appear a few minutes after you start exercising or after you finish a workout. Symptoms usually start to improve after about 30 minutes of rest.

Sometimes, exercise-induced asthma symptoms can return up to 12 hours after you’ve finished exercising. They can appear even when you’re at rest. These are called “late-phase” symptoms. It may take up to a day for late-phase symptoms to go away.

What causes exercise-induced asthma?

Intense aerobic physical activity can trigger exercise-induced asthma. It’s worse when:

• Air is cold and dry.
• Pollen counts are high.
• Pollution levels are high, causing poor air quality.
• You’re recovering from a cold or respiratory illness.
• You’ve breathed in smoke, chemicals or fumes from paint or cleaning supplies.

What activities trigger exercise-induced asthma?

Any activity can cause symptoms, but those that require constant physical exertion (with little rest) and cold-weather sports are the most likely to trigger asthma. Examples include:

• Basketball.
• Ice hockey.
• Ice skating.
• Long-distance running.
• Skiing.
• Snowboarding.
• Soccer.

Swimming, diving or playing water polo in an indoor, chlorinated pool can also irritate your lungs.

What are the risk factors for exercise-induced asthma?

People with asthma and allergies are more likely to have exercise-induced bronchoconstriction. It’s more common among elite athletes, like Olympic athletes and professional football, soccer and hockey players. Studies suggest between 30% and 70% of elite athletes have exercise-induced asthma.

How is exercise-induced asthma diagnosed?

Your provider will ask about your symptoms, including when you have them and how long they last. They’ll also ask if you have a family history of asthma or other airway conditions. They’ll listen to your heart and lungs and may perform additional tests. These include:

• Pulmonary function tests. These test how well your lungs are working. Spirometry is a common pulmonary function test for asthma.
• Exercise challenge. During an exercise challenge test (also called a bronchoprovocation test), you ride on a stationary bike or run on a treadmill. Your provider uses spirometry to measure your breathing before and after you exercise.
• Chest X-ray. Your provider might have you get a chest X-ray to rule out infections or other causes of your symptoms.

How is exercise-induced asthma treated?

Treatment for exercise-induced asthma focuses on preventing and relieving symptoms. In addition to preventive steps — like warming up before physical activity — your provider may prescribe medications that can help. Some drugs open your airways while you’re having symptoms and others prevent symptoms.

Medications for exercise-induced asthma

Your provider may prescribe medications you breathe in using an inhaler or a nebulizer. These can prevent or relieve symptoms. Inhaled medications for exercise-induced asthma include:

• Short-acting beta-agonists (SABAs). SABAs are a type of bronchodilator, which work by relaxing the muscles in your airways. Also called rescue inhalers, SABAs can relieve symptoms during an EIB episode. SABAs can also prevent asthma symptoms if you take the medication about 15 minutes before physical activity.
• Long-acting beta-agonist (LABAs). LABAs are another type of bronchodilator that’s combined with corticosteroids (they aren’t used alone to treat asthma). LABAs can prevent an EIB episode if you inhale the medication about 30 minutes to an hour before you exercise.
• Corticosteroids. Corticosteroids reduce swelling in your airways to increase airflow. Your provider may prescribe them to use daily to prevent symptoms.
• Mast cell stabilizers. Mast cell stabilizers reduce inflammation in your airways. You can inhale this medication using a nebulizer about 15 minutes before exercise to help prevent symptoms.

Leukotriene modifiers and antihistamines also help reduce asthma symptoms in some people.

Can exercise-induced asthma be prevented?

With planning and preparation, you may be able to avoid an asthma episode. Before physical activity, you should:

• Allow yourself time to warm up: Before starting any physical activity, warm up for six to 10 minutes. Warmup routines vary depending on your age, health and sport or activity. Talk to your provider about the right one for you.
• Check pollen and air quality: Before going outside to exercise, check the air quality index. If pollution and pollen levels are high, you may want to stay indoors.
• Cover your mouth and nose: Use a mask, scarf or gaiter to protect your airways from cold, dry air.
• Manage asthma symptoms: If you have asthma, work with your provider to manage your symptoms before you start an exercise program. Follow your provider’s instructions when using inhalers and taking asthma medications.
• Tell coaches and teachers: If your child has asthma, make sure teachers and coaches are aware. Adults should know what symptoms to watch for, what to do if symptoms appear and how to help with medications.
• Watch for symptoms: Monitor yourself (or your child) for symptoms of sports-induced asthma. Have a plan in place if you notice signs of an EIB episode. Remember that symptoms can appear minutes (or even hours) after you finish exercising.

Choose indoor or lower-intensity sports. If you have sports-induced asthma, you may want to choose certain activities over others. Endurance sports and activities that take place in colder temperatures are more likely to trigger symptoms. If you enjoy water sports, it may help to do them in a saltwater pool or bodies of water that aren’t chlorinated.

What sports are less likely to trigger exercise-induced asthma?

Indoor sports and those that are less intense or involve short bursts of activity are less likely to trigger an asthma episode. Examples include:

• Baseball.
• Bowling.
• Fencing.
• Golf.
• Gymnastics.
• Pickle ball.
• Sprints.
• Tennis.
• Volleyball.
• Walking.

What can I expect if I have exercise-induced asthma?

Many people with exercise or sports-induced asthma manage the condition and live active, healthy lifestyles. With proper planning and care, you can exercise and enjoy a variety of sports and activities.

How do I know if I have exercise-induced asthma?

If you have asthma symptoms that start during or shortly after physical activity, you might have exercise-induced asthma. But its symptoms can be similar to other conditions, so talk to a healthcare provider to get a proper diagnosis.

When should I see my healthcare provider?

If you or your child has symptoms of EIB, call a healthcare provider. If you can, keep track of and share with your provider:

• What kind of symptoms you have.
• What you’re doing when you have them. (Is it always during the same activity? Are you indoors or outdoors?)
• How long your symptoms last after they start.
• What relieves your symptoms, if anything.

If you’re prescribed an inhaler, make sure your provider shows you how to use it. Don’t be afraid to ask questions about proper use.

When should I go to the ER?

If you or your child has severe shortness of breath or trouble breathing, seek immediate medical attention. Call 911 or go directly to the emergency room.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• What can I do to avoid symptoms?
• Can I still participate in sports or activities I enjoy?
• How do I take this medication?
• Can you demonstrate how to use an inhaler?

A note from Cleveland Clinic

Whether you’re a weekend warrior or a seasoned athlete, asthma symptoms can really slow you down. But many people with exercise-induced asthma can continue to play sports, enjoy a range of activities and live active lifestyles. Taking a few extra steps, like including a warmup routine, can make a big difference. Talk to your provider about medications that can help you breathe easier. With lifestyle changes and prior planning, you can stay active and exercise safely.