While it was thought for years that breathing cold air exacerbated EIB, more recent studies indicate that the dryness of the air, rather than the temperature, is the more likely trigger. Cold air typically contains less moisture than warm air, and quickly breathing dry air dehydrates the bronchial tubes, causing them to narrow and restrict airflow.
Before the 2010 Winter Olympics, The New York Times reported that as many as half of all elite cross-country skiers, and almost that many world-class figure skaters and hockey players, have been diagnosed with EIB.
Here are some suggestions to relieve symptoms of EIB:
- Warm up with gentle exercises for about 15 minutes before you start more intense physical activity.
- Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.
- Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.
Sports and activities least likely to cause EIB symptoms:
- Sports that require only short bursts of activity, including volleyball, gymnastics, baseball, wrestling, golf, swimming, football and short-term track and field events. Some swimming events can demand constant activity, but the warmth and humidity from the water make it easier for people with EIB to breathe.
- Activities such as walking, hiking and recreational biking.
Sports and activities most likely to cause EIB symptoms:
- Sports or activities that require constant activity or are done in cold weather, such as soccer, basketball, long-distance running, ice hockey, ice skating and cross-country skiing.
Two types of medicines used to treat asthma are prescribed to prevent and treat EIB symptoms. They are most frequently administered through an inhaler, although some are available in tablet form:
- Short-acting inhaled beta2-agonists (bronchodilators) stop symptoms right away. They may be taken 15 to 30 minutes before vigorous exercise and generally prevent symptoms for two to four hours. These medications are extremely effective in treating or preventing EIB symptoms, so if symptoms do not improve, then consider alternative diagnoses.
- Long-term control asthma medicines are taken every day to prevent symptoms and attacks.
- Inhaled corticosteroids. These help to relieve narrowing and inflammation of the bronchial tubes and are the most commonly prescribed type of long-term asthma medication. It may two to four weeks before these drugs reach their maximum effect.
- Long-acting inhaled beta2-agonists (bronchodilators). Taken 30 to 60 minutes before exercise starts, these medications help prevent symptoms for 10 to 12 hours. They should be used only once within a 12-hour period, and they should be taken only in combination with an inhaled corticosteroid.
Elite athletes should check with the governing bodies of their sport about the medicines they are allowed to take to relieve their EIB or asthma symptoms. Another resource is the Prohibited List published by the World Anti-Doping Agency. Some medications (including, with some specific exceptions, beta2-agonists) are considered to be performance-enhancing drugs and cannot be used by athletes in competition unless a Therapeutic Use Exemption is granted for medical need.
If you continue to experience symptoms with exercise despite these recommendations, see your allergist to discuss what your next steps may be.