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Exercise-Induced Asthma

Reviewed by: HU Medical Review Board | Last reviewed: June 2024 | Last updated: June 2024

Exercise-induced asthma can occur in anyone, whether or not they have asthma. The condition happens in high school athletes, elite athletes, and people who enjoy recreational sports. If you cough, wheeze, or feel short of breath when you exercise, you too could have exercise-induced asthma.1-4

What is exercise-induced asthma?

Although asthma is typically a chronic (ongoing) condition, sometimes it occurs only with exercise. This is called exercise-induced asthma or exercise-induced bronchoconstriction (EIB). EIB occurs when the airways become narrow or tight during physical activity.1-6

In addition, exercise can trigger people with chronic asthma to have a flare. Up to 90 percent of people living with asthma have EIB. And up to 20 percent of people without asthma may have EIB.1,2

Who gets it?

Many avid exercisers and elite athletes have bouts of EIB. Things around you, such as cold temperatures or chlorine in a pool, also can play a role. These are called environmental factors.1-4

Higher-intensity sports can trigger or make the condition worse. These activities include:1,4

  • Long-distance running
  • Cycling
  • Downhill skiing and other high-altitude sports
  • Cross-country skiing
  • Ice hockey and ice skating
  • Swimming and water polo
  • Prolonged cardio sports like soccer and basketball

What are the symptoms?

Symptoms of EIB mimic other typical asthma symptoms, such as:1-4

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  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness or pain

Symptoms usually follow a pattern:2,3

  • Develop within a few minutes or up to 15 minutes after exercise
  • Peak within 10 to 15 minutes of prolonged exercise
  • Resolve with rest in 30 to 60 minutes after stopping exercise

Coughing is the most common reaction. You may have to stop your exercise and rest or use your inhaler.1

What causes exercise-induced asthma?

Various activities and environmental factors can cause EIB. Having a mild cold or asthma episode can also contribute.2,4

Prolonged activity

Vigorous exercise can trigger asthma symptoms. When you exercise, your body needs more oxygen. Rapid, deep breathing causes the airways to narrow. With EIB, airway muscle spasms and inflammation restrict airflow and trigger symptoms.1,2,4

Cold, dry air

Cold air often contains less moisture than warm air. Heavy or deep breathing in dry air causes the airways to narrow. So, cross-country skiers, hockey players, and other winter athletes are prone to exercise-induced asthma.1-4

Other environmental triggers

Other things in your environment that can cause EIB include:2,4

  • High pollen counts
  • High levels of ozone
  • Poor air quality
  • Chlorine byproducts in the air, especially near indoor pools
  • Other irritants such as smoke, perfume, or paint

How is it diagnosed?

If you have a hard time breathing during exercise, talk to your doctor. They may need to test you to diagnose exercise-induced asthma.1-4

Testing can include an exercise challenge to test your breathing and response during exercise. A lung function test measures how much air you can breathe out and how fast you can blow it out.1-6

Your doctor or allergist will also consider:2

  • Your medical history
  • The medical history of your family members
  • Your overall health
  • Possible other reasons for your symptoms

How to reduce symptoms

With a diagnosis, you can develop a plan to manage or prevent symptoms during exercise. You may have to adjust some of the sports you do, but EIB should not keep you out of the game. Regular exercise can actually improve long-term lung function and reduce airway inflammation in people with asthma and EIB.1-6

You can also reduce triggers by:4,5

  • Starting with a 10-minute warm-up before high-intensity intervals
  • Breathing through a face mask in cold, dry air
  • Trying to breathe through your nose
  • Not exercising when the air quality is bad
  • Avoiding exercising near fields or lawns that have just been mowed
  • Being mindful of airborne irritants, pollutants, and allergens

Medicine for exercise-induced asthma

Asthma medicine may help, depending on the severity of your symptoms and whether you have chronic asthma. There are several medicine options:3,4

  • Short-acting inhalers may be taken 5 to 20 minutes before exercise.
  • Long-acting bronchodilators help prevent symptoms for 10 to 12 hours.
  • Inhaled corticosteroids can relieve narrowing and inflammation of the bronchial tubes.
  • Leukotriene modifiers are taken before exercise and help prevent airway narrowing, inflammation, and mucus production.
  • Long-term control asthma medicines help prevent symptoms and attacks.
  • Antihistamines may be recommended for athletes with allergies.

By getting ahead of your symptoms and making simple changes, you can prevent flare-ups and resume your favorite sport or activity.