People with asthma have what is called a chronic or continuing problem with their airways, which can become swollen, narrowed, and clogged with mucus. To make matters worse, common stuff, like pollen and cigarette smoke, can worsen breathing problems and cause flare-ups.

Most people with asthma (up to 80%) have symptoms when they exercise. And some people have asthma symptoms only when they exercise. This is called exercise-induced asthma (EIA). Interestingly, up to 20% of people who don't have asthma sometimes develop asthma-like symptoms while exercising. This is why doctors sometimes call the condition exercise-induced bronchoconstriction, or EIB (bronchoconstriction refers to the narrowing of the airways in the lungs).

Symptoms of Exercise-Induced Asthma

Symptoms of EIA include wheezing, tightness or pain in the chest, coughing, and sometimes prolonged shortness of breath.

People with EIA will often start having symptoms 5 to 10 minutes after they begin working out. Symptoms usually peak 5 to 10 minutes after the person stops exercising then go away within an hour. Some people with EIA also have symptoms for hours after they exercise. Sometimes symptoms appear only after the person has stopped exercising. Really cold weather can make EIA worse.

Some people with EIA think that their problem is that they are out of shape. But there's an easy way to tell the difference. Someone who is simply winded from being out of shape will soon start breathing normally again after finishing exercising. But for someone with EIA, it may take up to an hour to recover and breathe normally again.

If you think you have EIA, you should tell your parents and see a doctor.

Diagnosis and Treatment of EIA

If your doctor suspects EIA, he or she may ask you questions about whether people in your family have asthma and what has triggered your symptoms in the past.

After taking a detailed history and performing a physical exam, the doctor may want to check your breathing after exercise. For 6 to 8 minutes, you might run on a treadmill, run outside, or do the activity that caused the flare-ups. Then, the doctor can see how you're breathing and if it seems like EIA.

If so, your doctor might recommend something called pretreatment, which means taking medication before exercise or strenuous activity. This is often the same fast-acting medication used for flare-ups, called rescue medication, which is usually inhaled directly into the lungs and works immediately to open up the airways. When taken before exercise, this can help to prevent symptoms of EIA.

If pretreatment isn't enough, your doctor may recommend that you also take daily controller medication. Controller medication works over time to help keep the airways in the lungs open.

Medication is an important part of controlling EIA. Many people find that if they take their medicine as prescribed by their doctors, they can work out with few or no symptoms.

Recommended Sports

Exercise is a good idea for everyone. There's no reason for you to stop participating in sports or working out because you have EIA. In addition to keeping you fit and keeping your weight healthy, exercise can improve your lung function by strengthening the breathing muscles in the chest. For this reason, doctors no longer tell people with asthma to avoid exercising and may in fact recommend it as part of asthma treatment.

Some sports are less likely to cause problems for people with EIA than others, though. Some recommended activities include:

• walking
• jogging
• hiking
• golf
• baseball
• football
• gymnastics
• shorter track and field events

Endurance sports, like long-distance running and cycling, and those that require extended energy output, like soccer and basketball, may be more challenging. This is especially true for cold-weather endurance sports like cross-country skiing or ice hockey.

But that doesn't mean you can't participate in these sports if you truly enjoy them. In fact, many athletes with asthma have found that with proper training and medication, they can participate in — and even excel at — any sport they choose.

Tips for Dealing With EIA

When it comes to EIA, staying one step ahead of your symptoms is a good strategy. Ask your doctor about precautions you should take before exercising or playing sports. These are common recommendations for people who have EIA:

• Warm up carefully before any exercise to prevent chest tightening.
• Take prescribed medication as close to the start of exercise as possible.
• Breathe through your nose during exercise.
• Take brief rests during exercise and use rescue medication as prescribed if symptoms start.
• Cool down after exercise.
• Avoid exercising outside during really cold weather; if you have to, wear a scarf around your nose and mouth or a ski mask.
• If pollen or pollution also trigger your asthma, work out indoors on days when the air quality is bad or the pollen count is high.
• Don't exercise when you have a cold or the flu.
• Don't exercise if you are having asthma symptoms.

Taking medication exactly as your doctor prescribes is the most important tip of all. Skipping controller medications can make symptoms worse. Forgetting to take medication before exercise can lead to severe flare-ups and even emergency department visits.

Be sure to keep your inhaler with you when exercising. Though you may feel shy about your asthma, don't try to hide it. Coaches especially should know about it so they will understand if you need to take a breather and use your medicine.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2010