Exercise-induced bronchoconstriction, or EIB, is the preferred term for what was known for years as exercise-induced asthma. Symptoms develop when airways narrow as a result of physical activity. As many as 90 percent of people with asthma also have EIB, but not everyone with EIB has asthma. Many elite and world-class athletes have EIB – including Olympic medal winners in sports like cross country skiing, figure skating and ice hockey. EIB didn’t hold them back, and it shouldn’t hold you back either. An allergist will customize a treatment plan that allows you to get back to the exercise you love, and feel better while doing it.
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EIB is caused by the loss of heat, water or both from the airways during exercise when quickly breathing in air that is drier than what is already in the body. Symptoms typically appear within a few minutes after you start exercising and may continue for 10 to 15 minutes after you finish your workout. Anyone can experience these symptoms (especially someone who is out of shape), but with EIB, they are more severe. Wheezing in children after physical activity is often the first symptom of asthma.
Common symptoms of EIB include:
- Shortness of breath or wheezing
- Decreased endurance
- Tightness in the chest
- Upset stomach
- Sore throat
EIB triggers include airborne irritants related to specific sports. Examples are:
- Chorine when swimming
- Pollution while running or cycling
- Cold, dry air while ice skating or playing hockey
- Air temperature during hot yoga.
When you are working out or competing in a gym, perfume, cleaners, paint, and new equipment or carpet could also be triggers.
While it was thought for years that breathing cold air makes EIB worse, more recent studies indicate that the dryness of the air, rather than the temperature, is more likely the 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.
The sports and activities that are most likely to cause EIB symptoms require constant activity or are done in cold weather. These include soccer, basketball, long-distance running, ice hockey, ice skating and cross-country skiing.
The activities that are least likely to cause EIB symptoms include walking, hiking and recreational biking, or sports requiring only short bursts of activity. These include volleyball, gymnastics, baseball, wrestling, golf, swimming, football, and short-distance track and field sports. Some swimming events can demand constant activity, but the warmth and humidity from the water make it easier for people with EIB to breathe.
Do you have EIB? Sometimes this can be difficult for athletes to know. Everyone has had trouble completing a workout at times, and athletes don’t often think of EIB or asthma as the cause. An allergist can determine whether your symptoms are exercise-induced alone, are a reaction to allergens or irritants in the air, or are an indication of underlying asthma.
As part of an examination, your allergist will take a history (including asking for information about any relatives with asthma or other breathing difficulties). You also may be asked for specific details about your physical activity, including where and how often you exercise. Your allergist will also consider other conditions, such as upper-airway problems, that might play a role in your difficulties with exercise.
To check how exercise affects your breathing, your allergist may measure your breathing before, during and after you run on a treadmill or ride an exercise bike. During the test you will breathe into a tube that connects to a spirometer, a device that measures the volume of air being inhaled and exhaled.
In some cases, environmental factors may contribute to EIB. Skaters and hockey players can be affected by a combination of cold, dry air in ice rinks and pollutants from ice-resurfacing machines. EIB in distance runners has been linked to exercising in high-allergen and high-ozone environments. In addition, indoor air with high levels of trichloramine, a chemical used in pool chlorination, has been linked to asthma and EIB in swimmers.
Treatment and Management
Two types of medicines used to treat asthma are also used to prevent and treat EIB symptoms. They are usually taken through an inhaler, though 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, let your allergist know.
- Long-term control asthma medicines are taken daily to prevent symptoms and attacks.
- Inhaled corticosteroids. These are the most commonly prescribed long-term asthma medications. They help to relieve narrowing and inflammation of the bronchial tubes. It may take two to four weeks before these drugs reach their maximum effect.
- Long-acting inhaled beta2-agonists (bronchodilators). Taken 30 to 60 minutes before exercise, 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.
- Montelukast, a leukotriene receptor inhibitor, is also approved for the treatment of exercise-induced asthma symptoms. Taken once daily, this medication can help prevent symptoms that accompany exercise.
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 beta2-agonists) are considered performance-enhancing drugs and cannot be used by athletes in competition unless a Therapeutic Use Exemption is granted for medical need. Your allergist can help you answer questions about your medications.
Other suggestions for relieving symptoms of EIB include:
- 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.
- Avoid triggers by making changes to your exercise routine.
- See an allergist to discuss prescription medications, which may be more effective than over-the-counter treatments.