Breathing Easier with Exercise-Induced Asthma

by Neil Schachter M.D.

“Dr. Schachter, have you been daydreaming?” my tiny but feisty patient demanded. “I just told you that making breakfast or washing my hair makes me short of breath. Now you want me to go out and exercise?” Struggling not to chuckle at being scolded like a schoolboy, I hastened to assure her that I was not suggesting she buy a leotard and sign up for spin classes, although, I’d be the first to admit exercise can play a valuable role in pulmonary health, as long as it’s a specialized and well-monitored program.

I have found that many asthmatic patients, because they experience discomfort from asthma, shrink away from physical activity. This is unfortunate because it creates a cycle that actually decreases general health. If people with asthma find that they become breathless from exercise, then they become more sedentary. The more sedentary they become, the more muscles weaken. They are less able to transport oxygen around, which increases breathing problems.

Sitting on a gurney in the emergency room, Bruce Taggert looked very worried. Recently divorced at thirty-five, he had decided to get in shape and lose those twenty pounds that he had gained since college. He bought a pair of ergonomically correct running shoes and set out to run the weight off. He felt pretty good for the first ten minutes, then his chest became tight and he found it difficult to breathe. By the time Bruce saw his doctor, he felt fine and an EKG showed no abnormalities. But when he tried running again, the symptoms recurred. I learned that he had seasonal allergies to ragweed and that his mother had asthma. Further pulmonary tests confirmed my suspicions—Bruce had exercise-induced asthma, or EIA.

Exercise-induced asthma results from a narrowing of the airways following exertion. About 90 percent of people with asthma experience the symptoms to some degree. For people like Bruce, it can be the first time they realize an asthma problem exists. Fortunately, EIA is one of the most preventable and/or treatable forms of asthma. In fact, many competitive athletes with EIA continue to beak records and win medals. Interestingly, about 10 percent of people without asthma will develop similar symptoms after exercise.

While doctors do not fully understand the precise mechanisms behind EIA, a number of key factors have been identified. We realize that the temperature and the moisture of the air we breathe is inhaled through the nose, where it is hydrated and warmed to body temperature before reaching the lungs. During exercise, we tend to breath through the mouth. As a result, the air is dry and cool when it reaches the airways, leading to airway irritability and constriction.

This effect is particularly rapid when you exercise in colder weather. Ice skating, skiing and running in winter can precipitate asthma symptoms. To make matters worse, when we breathe in through our mouths, we gulp in large amounts of pollutants that are suspended in the air. Doctors suspect this increased level of environmental irritants may also set off hyperactive airways.

Fortunately, exercise-induced asthma responds well to a range of treatment strategies. Simply wrapping a scarf over your nose and mouth in cold weather may be all you need to avoid EIA. In the summer months, a small facemask will serve the same purpose. Changing the type of sport you play can also be beneficial. The warm, humid conditions of swimming are less likely to cause EIA than running or cycling. Unfortunately, fumes from the chlorine added to most pools can be irritating to already hyperactive airways. To avoid pulmonary hazards, I prefer that my patients swim in an ocean or a lake whenever possible.

An additional benefit of exercise for asthmatics is that the increased exercise will almost invariably result in weight loss, which is very beneficial for most asthmatics. The weight you’re carrying means that your heart and lungs have less body mass to supply oxygen to; this will usually translate to a lessening of symptoms. Now is the time to start a traditional and dedicated exercise program to improve the fitness of your entire body.

Most asthmatics experience a tightness or a wheezing upon exertion, and anyone with a long history of asthma knows that running and physical exertion can trigger an asthma attack. Between 80 to 100 percent of asthmatics will experience symptoms upon exercise, but this does not mean that asthmatics cannot exercise. The list of elite and Olympic athletes that have asthma is impressive, including Jackie Joyner Kersey, Dennis Rodman, Greg Louganis and Aaron Carver. Up to 40 percent of elite athletes in different sports experience a type of exercise-induced bronchospasm, or asthma, at high levels of exertion.

Excerpted from Life and Breath by Neil Schachter, M.D. Copyright© 2003 by Neil Schachter, M.D by permission of Broadway, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.