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Health & Exercise Forum

Exercise-Induced Asthma (EIA)

Mar 8, 2009

Guest author: Gregory Cali, DO, pulmonary physician

Dr. Paul MackareyOn a recent bus ride to an Eagles game I asked my friend Dr. Gregory Cali, a local pulmonologist, (lung doctor) to help me with an article on exercise-induced asthma. The topic was chosen in response to an email question from a concerned mother of an athlete with asthma.  Believe it or not, we spent almost two hours talking about asthma, which helped make the trip seem very short.  Dr. Cali informed me that the first thing to know about exercise induced asthma (EIA) is that EIA is not a distinct disease in itself-but is one manifestation or presentation of asthma. Putting it simply EIA occurs in patients who have develop narrowing of the bronchial tubes ( bronchoconstriction) when they exercise.  Some experts would rather we use the phrase exercise induced bronchoconstriction which is what happens when someone has an asthma attack.  This bronchoconstriction occurs because of spasm of the tiny muscles of the airways, plugging of the airways with thick mucous, and swelling or edema of the cells lining the airways.

In fact it is inflammation of the airways, mostly due to allergies, that is at the root of most cases of asthma. This inflammation causes the bronchial tubes to become over-reactive-and predisposed to narrowing- when exposed to certain triggers.  Exercise is one of those triggers in susceptible people. The patient with EIA complains of chest tightness, wheezing, and shortness of breath when exercising.  Some patients only experience coughing with exercise.  Symptoms are usually worse in cold, dry air. This is believed to be due to the drying and cooling of the airways, which occurs with exercise, especially if the patient opens his or her mouth while exercising.  Nasal breathing is much better at warming and humidifying air and may help to reduce EIA.

Dr. Cali feels that the most important point about EIA is to make sure a specific diagnosis is made.  It is difficult at times to differentiate asthma from the normal breathlessness, which occurs with exercise.  The feature of EIA that distinguishes it from normal breathing, or being "out of shape" is the fact that EIA is ALWAYS associated with a decrease in airflow.  This can be measured with either a peak flow meter or a spirometer.  It is also important that a specific diagnosis be made so that a person will not be labeled as asthmatic when they may be "normal" or have other conditions such as heart problems or anemia.

Dr. Cali recommends before a person is labeled asthmatic, they have spirometric testing.  An improvement in airflow after inhaling a bronchodilator is an important indicator of asthma.  Sometimes a bronchial challenge test is needed to diagnose asthma.  In this test, the subject breathes in a known bronchoconstrictor in small quantities and the response is noted.  Patients with asthma almost always respond to the inhaled agent by a reduction in airflow.

Prevention and management

Dr. Cali offers the following advice to prevent and manage EIA:

Whatever the patient can do to warm and moisten the inhaled air can help prevent EIA.  Nose breathing during exercise or wearing a loose covering over the mouth in cold weather may help.  Sometimes, in severe cases, switching to an indoor sport like swimming may be necessary.  It is important to start out slowly and warm up first before exercising at full tilt.

Medications may be necessary.  Quick- acting bronchodilators like albuterol  used 15-20 minutes before planned exercise is recommended.  This can be repeated once more during the exercise, but if tightness or wheezing occurs, the exercise should be stopped. Many patients with asthma require preventative treatment with anti-inflammatory medications.  Inhaled steroids and/or leukotriene inhibitors may have to be added if the asthma is not controlled with albuterol alone.  In fact, some patients with asthma who are overly reliant on quick acting bronchodilator medications can get into serious trouble if they do not use inhaled steroids.

In conclusion, people with asthma should not shy away from exercise.  With proper precautions, people with asthma should be able to participate in all kinds of sports activities: football, soccer, swimming, baseball, tennis and running (even a marathon)! The key point is that the asthma needs to be under control and monitored by the patient and doctor as a team.

By the way, the Eagles went on to crush the 49ers !

Visit your doctor regularly and listen to your body.