EXERCISE-INDUCED ASTHMA (OR EIB)

by Melinda Burris Willms

      The body requires more oxygen when exercising to supply the necessary energy to complete the actions being demanded of it. Because of this, proper breathing is of paramount importance to ensure you complete your exercise to your fullest ability at optimum comfort and safety levels. The body needs a steady intake of deep breaths to stimulate oxygen transference to fuel the muscles and a consistent release of deep breaths to rid itself of carbon dioxide and other wastes.¹

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WHAT IS EIB?

Anyone who does not breath properly while exercising or physically overextending themselves can experience shortness of breath. According to the Asthma and Allergy Foundation of America (AAFA), when airflow obstruction happens due to exercise, the correct term for this state is exercise-induced bronchoconstriction (EIB). Although this condition was often referred to as exercise-induced asthma in the past, this term is no longer used by medical professionals as the name gives the false impression that participation in exercise causes asthma.²

Participation in physical activity that makes the body work causes shortness of breath as the body works to feed that required oxygen to the muscles in order to keep going. This often results in breathing more heavily than usual and this can result in dehydration which can restrict the airway, blocking passage to the lungs in individuals, whether they have asthma or not. The proper medical term for the occurrence of the airway becoming blocked in this way is bronchoconstriction.³

While bronchoconstriction is a common place occurrence among most individuals, people who have asthma will experience stronger symptoms than those who do not. This is because asthmatics generally already have inflamed airways and have a higher level of mucus production. This means their airways are typically already narrow and exercising exacerbates this preexisting condition, making breathing through strenuous exercise particularly difficult. In fact, EIB is so common in asthma sufferers, the AAFA estimates some 90% of individuals with asthma have experienced EIB while exercising. EIB is especially common in teenagers and those in their early twenties.²

EIB SYMPTOMS

The most frequently experienced EIB symptom is coughing, and for many, it is the only symptom they will feel.² There are a range of other symptoms associated with EIB such as wheezing, tightness in the chest, shortness of breath, sore throat, and diminished level of endurance.^2,3

In most cases, people do not experience the symptoms of EIB when they first begin to exercise or take part in vigorous physical activity. Generally, these symptoms begin to manifest at some point during exercise and will actually get worse in the 10 to 15 minutes following completion of the workout.^2,3

The severity of EIB symptoms depends on the individual and can range from slight to serious. Symptoms generally subside within 20-30 minutes after peaking. There is a phenomenon known as second wave or late-phase symptomology where individuals will experience another attack within a 4-12-hour timeframe after exercise has ceased. Such second wave attacks typically involve milder symptoms but can take up to 24 hours to subside.²

PREVENTATIVE MEASURES FOR EIB & ASTHMA ATTACKS

Preventative measures are highly successful in either preventing asthma attacks or decreasing the gravity of the symptoms. The following are recommendations from experts for preventing asthma attacks and handling symptoms during exercise:

• Be sure to comply with your physician’s directions regarding any asthma medication you should use and take it as instructed.³
• If you have been diagnosed with asthma, you should always carry your rescue inhaler on you, even when working out or competing, in case of severe asthma attack.³

MEDICATIONS FOR EIB

Medications used for the prevention and/or treatment of EIB fall into one of three different classifications. If you have experienced the symptoms of EIB, consult with your physician and a course of treatment will be recommended for you based on your personal history and the kind of exercise in which you participate.²

1. A bronchodilator or short-acting beta agonist: This is a preventative drug that can help you avoid the symptoms of EIB if you take it 10-15 minutes prior to beginning exercise. This drug is also used to treat EIB symptoms in progress.²
2. A long-acting bronchodilator (Salmeterol): This medication should be taken 30 minutes to one hour prior to beginning exercise. It can be taken just once every 12 hours. This medication has proven effective at preventing symptoms of EIB for up to 10-12 hours. This drug is not effective for addressing an attack in progress.²
3. Mast cell stabilizers: Nedocromil sodium (Cromolyn sodium) should be administered 15-20 minutes prior to exercise. These drugs can assist in the prevention of “second wave” EIB attacks but are not effective in treating EIB symptoms in progress. Short-acting bronchodilators and mast cell stabilizers are sometimes prescribed to be used together in combination.³

ADDITIONAL PREVENTATIVE MEASURES

• Proper warmups are important for all athletes prior to workouts. For those who suffer with asthma, warmups are especially important as they can help “to loosen the airways and move mucus around.”³
• Proper cool down exercises are also important as they allow the body to slowly adjust back to normal breathing patterns.³
• Exercising outdoors in cold months or when pollen levels are high increases the risk of an attack. As a precaution, it is suggested that asthma sufferers cover their nose and mouths with a scarf to protect their air passageways.³
• If you have any type of viral infection, steer clear of exercise until you are well again.³
• If possible, choose a sport or type of exercise that is less likely to aggravate your asthma. Sports and exercise that rely heavily on the respiratory system and that involve being in compromised atmospheres are more likely to trigger an attack.³

References

1. Summit Medical Group. (n.d.). Proper Breathing During Exercise.
2. Asthma and Allergy Foundation of America (AAFA). (October 2015). Exercise-Induced Bronchoconstriction (Asthma).

3. Medical News Today. (2004-2020). What to Know About Exercise-induced Asthma.
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