Chapter 9

Asthma and Exercise

In This Chapter

Knowing how exercise can trigger asthma symptoms

Maintaining fitness with asthma

Making the connection between asthma and athletes

Y ou don’t have to sit on life’s sidelines just because you have asthma, even though most asthmatics are susceptible, in varying degrees, to symptoms of exercise-induced asthmaexercise-induced bronchospasm

Understanding EIA

Typically, EIA symptoms start minutes after you begin vigorous activity, when the airways in your lungs become narrow and constricted. These respiratory symptoms usually reach their peak of severity between five and ten minutes after you stop exercising. In many cases, the symptoms can spontaneously resolve (without the use of a short-acting inhaled bronchodilator) within 30 minutes.

Exercises that involve breathing cold, dry air, such as running outdoors or skiing, are more likely to trigger EIA than activities that involve breathing warmer, humidified air, such as swimming in a heated pool. However, a few studies have also cautioned that chlorine and other chemicals used in heated and non-heated pools seem to also act as EIA triggers in some asthmatics.

Although EIA usually relates to outside activities, using home-exercise equipment or simply running upstairs can precipitate an asthma episode in some people. If you have an increased sensitivity for EIA, make sure that your doctor knows so that he can evaluate and treat your condition.

Keeping Fit Despite EIA

Although EIA symptoms occur frequently in asthmatics when they exert themselves vigorously, for certain individuals, physical activity may be the only trigger that precipitates respiratory symptoms such as coughing, wheezing, and shortness of breath. Occasionally, patients mistakenly attribute their EIA symptoms to just “being out of shape,” rather than seeking a proper medical diagnosis.

However, if you’re experiencing respiratory symptoms connected to exer- cise and other types of intensive physical activities, make sure that you get a proper diagnosis. Although EIA episodes usually last for only a few minutes, they can still be frightening for many people and, as a result, could unnecessarily limit your physical activities.

Diagnosing EIA

Properly diagnosing and treating EIA usually means that you can enjoy an active lifestyle. Doctors can often prescribe medications to prevent or at least substantially reduce your EIA symptoms, thus allowing you to participate in many types of exercise and sports in spite of your asthma.

Receiving appropriate treatment for EIA is also essential for your well-being because so many people in the United States and other developed countries simply don’t get enough exercise. According to a recent report by the Centers for Disease Control and Prevention (CDC), adult asthmatics in the United States are even less likely on average to meet national recommendations for physical activity than nonasthmatics.

I’m not suggesting you run a marathon tomorrow, but as I emphasize in many other parts of this book, staying in good physical shape can only help in managing your asthma (and any other ailment) successfully. So don’t let your susceptibility to EIA keep you from getting the exercise you need. Rather, consult with your doctor to find effective ways of managing your condition that can also allow you to stay in shape.

Keeping a record of your activities and noting when you experience asthma symptoms and what steps you normally take to relieve them can assist your doctor in developing the most effective treatment program. Because certain drugs are more effective in preventing and controlling EIA, when you take your prescribed medication is often just as important as what you take. Work with your doctor to determine the best time to take your prescribed medication in order to ensure that it provides maximum relief.

Controlling EIA with medications

In many cases, competitive athletes with asthma or EIA use inhaled cortico- steroids daily to control their airway inflammation. Many competitive athletes also add a long-acting inhaled beta ₂ -adrenergic bronchodilator daily, such as salmeterol (Serevent, Serevent Diskus) or formoterol (Foradil), and/or a short-acting inhaled beta ₂ -adrenergic bronchodilator, such as albuterol (Proventil, Ventolin), prior to exercise or athletic events.

To prevent EIA, your doctor may recommend that you inhale your dose of prescribed short-acting beta ₂ -adrenergic bronchodilator 15 to 30 minutes before you begin to exert yourself. The long-acting bronchodilators salmeterol — available in dry-powder inhaler (DPI) formulation as Serevent Diskus or as Serevent MDI in a metered-dose inhaler (MDI) — and formoterol, available only as a DPI as Foradil Aerolizer, may be prescribed for use 30 minutes before exercising. Doctors usually prescribe these medications as part of combination therapy with inhaled corticosteroids. (See Chapter 14 for the differences between DPIs and MDIs.)

Other long-term controller drugs that doctors also prescribe to treat EIA symptoms include cromolyn (Intal) and nedocromil (Tilade), which are both inhaled mast cell stabilizers (see Chapter 15). These products are also usually best taken 15 to 30 minutes before exercising. Recent studies have shown that when taken regularly, montelukast (Singulair), a leukotriene inhibitor (also see Chapter 15), may also be an effective long-term, preventive treatment for EIA.

Athletes and EIA

According to recent studies of respiratory conditions, Olympic-level competitors as a group are most likely to experience EIA episodes. Research indicates that hard breathing by these competitors during sports events and intensive workouts may be an important factor in triggering their respiratory symptoms.

Breathing competitively: Nose versus mouth

Another reason for athletes being at increased risk for EIA is due to the fact that all people — not just Olympic champions — switch from nose breathing to mouth breathing when they’re strenuously exerting themselves. As I explain more extensively in Chapter 7, one of your nose’s most important functions is to protect your airways from particulate matter in the air. Your nose acts to filter and cleanse the air you inhale, through cilia (tiny hair-like projections of certain types of cells that sweep mucus through the nose).

However, filtering isn’t in your mouth’s job description. Therefore, when you’re seriously exerting yourself and gulping in air through your mouth, you’re also increasing the chances of inhaling allergens and irritants that can more easily get into the airways of your lungs and potentially trigger more serious reactions.

Because your body needs all the oxygen it can get when you’re vigorously working out and/or competing, breathing through your mouth can virtually be a reflex, which is all the more reason to make sure that you’re taking medications to prevent or at least reduce the severity of EIA symptoms.

Contrary to popular myth, sports federations such as the National Collegiate Athletic Association (NCAA) or the U.S. Olympic Committee haven’t banned the use of inhaled corticosteroids that athletes take on a regular basis to control asthma symptoms. (The steroids that various sports committees ban are actually male hormones that some athletes take by tablet or injection to build muscle mass.) However, some common over-the-counter (OTC) medications, such as pseudoephedrine (Sudafed), are banned due to their stimulant effects. Check with your sports federation before taking any medication, including OTC products.

Warming up and cooling down to prevent EIA

Many doctors also advise some type of warm-up and cool-down routine (even if you don’t have asthma) when engaging in exercise or sports-related activity. Consult with your physician to determine the type of pre- and post-exercise routine that’s most beneficial for you. After you’ve determined the warm-up and cool-down plan, incorporate that routine into your asthma management plan.

As long as you stick to your asthma management plan, asthma shouldn’t prevent you from enjoying or even excelling at a wide range of physical activities. Consider the examples of Jackie Joyner-Kersee and other Olympic champions who also suffer from asthma. (See Chapter 22 for more famous folks with asthma — the list may surprise you!)