Exercise-induced Asthma or Bronchoconstriction
by Melinda Burris

This article explores exercise-induced asthma, also known as exercise-induced bronchoconstriction (EIB), including what it is, who is at risk for it, the signs and symptoms of EIB, and how it should be treated and managed.

If you have difficulty breathing and experience asthma-like symptoms while exercising you may have exercise-induced asthma, referred to medically as bronchoconstriction. Medical professionals prefer the term bronchoconstriction as it is felt that calling the condition exercise-induced asthma gives the false impression that exercise causes asthma. This is not the case. You must have an underlying condition for exercise to trigger an asthma attack.¹

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When you train intensely or participate in vigorous exercise, shortness of breath is to be expected as your body is pumping more oxygen to allow you to keep up the heightened pace. With exercise-induced bronchoconstriction, the airway actually becomes constricted and inflamed while you are exercising. EIB is very common among people who have asthma with an estimated 90% of asthma sufferers also having EIB. However, it is also possible to have exercise-induced bronchoconstriction if you do not typically suffer from asthma.¹

Symptoms of EIB

Numerous symptoms point to EIB. The most prominent one is coughing, and in some cases, which may be the only symptom to manifest. Other common symptoms include shortness of breath, tightness or pain in the chest, feeling fatigued during exercise (when you are otherwise fit), subpar athletic performance, gastrointestinal discomfort, and a tendency to avoid physical activity (seen primarily in children with EIB). Symptom intensity varies from mild to acute.^1,2,3

Generally, an episode of EIB begins within three minutes of beginning to exercise. The attack reaches its peak within 10-15 minutes, and symptoms usually resolve within an hour of stopping exercise. Some individuals do experience what is known as “a second wave (“late-phase”) of symptoms four to 12 hours after stopping exercise.”¹ Second wave symptoms are less acute but can take as long as 24 hours to resolve.¹

Causes of EIB

EIB can be triggered by several things, but all can be traced back to one of three root factors: medical conditions, medications, and environmental factors. ³ Precisely what causes EIB is unclear. For many years, it was believed cold air caused EIB. However, recent scientific studies have shown that dry air is more likely to trigger EIB because dry air contains more moisture than warm air. Cold air has less moisture in it than warm air. When a person breathes in cold, dry air, the air passages become dehydrated, and this causes them to tighten. This constriction of the airways reduces the available airflow and causes an EIB attack. Fumes that irritate the airway linings, including chlorine can also make breathing difficult.²

Groups at Elevated Risk of EIB

As mentioned previously, people who have traditional asthma are likely to also have EIB, with around 90% of asthma patients also having EIB. The condition is also more frequently found in elite athletes.² Conditions and factors that increase the risks of EIB include air pollution, cold air, dry air, chlorine fumes from pools, and fumes from other substances including paint, perfume, new carpeting, and even new exercise equipment.¹

Treatment

Treatment for EIB generally includes the use of inhalers and other asthma-controlling prescribed medications. Once you are diagnosed, your care provider will put you on medication to prevent and treat symptoms. If you feel you may have EIB, you should consult your health care provider and have a physical done. They will also draw blood to run labs to rule out other diagnoses.^1,2 This is important because the symptoms associated with EIB are also associated with other medical conditions so you must get a proper clinical diagnosis and not try to self-diagnose or treat yourself. If you are diagnosed with EIB, be sure to be compliant with your medical professional’s instructions and the directions for when and how to take your meds. You should make sure you have taken your medication before working out again as the best treatment for EIB is to prevent it from occurring.³

Complications

Symptoms that point to EIB should not be ignored. Treat any suggestion of this condition seriously and see a medical professional. Left unchecked, EIB can cause severe, even life-threatening difficulties breathing, especially among those who also have traditional asthma and are not receiving or complying with proper treatment and management of the disease. Untreated EIB can also cause you to have a lower quality of life due to your inability to exercise.²

Sports Known to Trigger EIB & Sports Less Likely to Cause an Asthma Attack

Sports that take place in cold/dry weather conditions such as ice hockey, skiing, and ice skating are more likely to trigger an EIB attack because of the atmospheric conditions. Activities such as long-distance running, swimming, and soccer that require constant activity and long periods of deep breathing are also more likely to trigger an attack.²

If you have EIB, take part in activities that are less likely to trigger your condition. Some suggestions include walking, biking at a moderate pace, baseball, and gymnastics. Exercise is important for everyone, including those with EIB, to prolong good health and increase your quality of life. With proper medication and selecting activities that do not aggravate your condition, individuals with EIB can perform well in a variety of sports. It is worth noting that many Olympic athletes and elite athletes can perform at optimal levels in their chosen sport.¹

Ways Exercise Can Help Alleviate Asthma

While exercise can’t cure EIB, it can help improve lung function and help you lose weight or maintain a healthy weight, which is important because your weight can affect blood flow and lung function. Exercise benefits your entire body and some of these health benefits can help you keep your asthma well-controlled. Exercise has also been proven to reduce stress and anxiety, two things that are known to trigger asthma attacks.¹

References:

1. Asthma and Allergy Foundation of America. (2024).“Asthma: Exercise-induced Bronchoconstriction.”
2. The Mayo Clinic. (7 December 2022). “Exercise-induced Asthma.”
3. Garry, J.P. (16 February 2024). “Exercise-Induced Asthma.”

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