How to Work Out When You Have Exercise-Induced Asthma

If going for a run has you huffing and puffing more than normal, you may have exercise-induced asthma, medically called exercise-induced bronchoconstriction. This type of asthma can be serious and make it hard to do the things you enjoy, Sadia Benzaquen, MD, a pulmonologist and chair of the pulmonary, critical care, and sleep medicine department at the Einstein Medical Center in Philadelphia, tells SELF. “It can impact your life—you may not be able to go for a hike with friends or play a soccer game without feeling uncomfortable,” he says.

The good news is that exercise-induced asthma is totally treatable—and it doesn’t have to interfere with your workouts. In fact, experts say exercise can actually help you manage asthma¹ as long as you’re following your doctor’s instructions for doing it safely.

Ahead is everything you need to know about exercise-induced asthma, including tips for maintaining your exercise regimen.

As its name implies, exercise-induced asthma is when you experience trouble breathing while pushing yourself physically.

Asthma is a condition that happens when the airways in your lungs become inflamed and narrowed, resulting in symptoms like chest tightness and pain, coughing, a whistling sound when you breathe (wheezing), and shortness of breath, according to the National Heart, Lung, and Blood Institute (NHLBI). Some people only experience this while they’re working out, hence the name “exercise-induced asthma.”

Experts often refer to exercise-induced asthma with the more specific name “exercise-induced bronchoconstriction.” This is to clarify that while strenuous exercise may trigger the airways in your lungs to narrow (known as bronchoconstriction), it’s not a root cause of asthma, according to the Mayo Clinic. 

Geoffrey Chupp, MD, a pulmonologist at the Yale School of Medicine, tells SELF that some people can have exercise-induced asthma and no other asthma symptoms outside of strenuous activities. Other individuals may have asthma that can strike at any time but gets triggered when they exercise.  

About 90% of people with asthma experience symptoms when they exercise, and about 10% of people only have exercise-induced bronchospasm, according to the Cleveland Clinic. Either way, Dr. Chupp says he considers exercise asthma “real asthma.”

Back to top

Though there may be many causes of exercise-induced bronchoconstriction, experts have pinpointed one main factor. “Because you’re inhaling a large volume of air beyond what you normally would, an inflammatory reaction occurs and causes narrowing of the airways and mucus production,” Emily Pennington, MD, a pulmonologist at the Cleveland Clinic, tells SELF.

While physical activity is the main trigger of exercise-induced bronchoconstriction, different factors can trigger an attack or make it worse, according to the Mayo Clinic.

Back to top

If an attack strikes every time you’re active, it’s important to understand asthma triggers that can force your airways to constrict and lead to asthma symptoms²:

• Activities that require a lot of deep breathing, like long-distance running, swimming, or soccer
• Cold or dry air
• Air pollution
• High pollen counts
• Swimming pool chlorine
• Having a respiratory infection or lung disease³

Back to top

Just like with chronic asthma, exercise-induced bronchoconstriction can lead to symptoms like coughing, wheezing, chest tightness and pain, and shortness of breath. But you can also experience exercise-specific issues, like an abnormal level of fatigue during your workouts. All of this can make people feel out of shape when they’re actually not. 

These symptoms can start just a few minutes into a workout session, but like with most health conditions, everyone is different. “I’ve had patients be well into exercise and then all of a sudden they can’t function,” Raymond Casciari, MD, a pulmonologist at Providence St. Joseph Hospital in Orange, California, tells SELF.

While exercise-induced asthma symptoms can be different from person to person, and range from mild to severe, here are some common signs to watch out for:

• Coughing after exercise: For some people, coughing during and after exercise is their only symptom of exercise-induced asthma.
• Trouble breathing or shortness of breath: During an exercise asthma flare, it might feel hard to push air out of your lungs. “People describe it as feeling like they’re breathing through a tiny straw,” Tina Sindher, MD, an allergist and immunologist at Stanford Health Care, tells SELF.
• Wheezing: Your breathing may sound high-pitched, almost like a whistle.
• Tightness in your chest: You might feel like there is a load of bricks sitting on your chest.
• Intense fatigue: We’re not talking about just feeling tired after a workout. People with exercise-induced asthma often feel completely exhausted during and after workouts.

Back to top

How is exercise-induced asthma diagnosed?

If you regularly experience any of the above symptoms, check in with your primary care doctor, who can examine you or refer you to a specialist for testing.

To test for exercise-induced asthma, your doctor can perform lung tests to figure out how well you can breathe when you’re not exercising. This helps show if you have underlying asthma unrelated to exercise or just exercise-induced bronchoconstriction, according to the Mayo Clinic.

A common lung test is called a spirometry test. It uses a mouthpiece connected to an instrument called a spirometer to measure how much air you inhale and exhale, and how quickly you can exhale it. After you take the spirometry test, your doctor will probably give you a bronchodilator, which is an inhaled medication that opens up your lungs, per the Mayo Clinic. You’ll then do the spirometry test again, and your doctor will compare the results to see if the bronchodilator helped improve your airflow. If it did, you might have underlying asthma that just gets worse when you exercise instead of solely having exercise-induced bronchoconstriction.

Your doctor may also put you through something known as an exercise challenge, which is when you run on a treadmill or ride on a stationary bike to get your breathing up so they can see what’s happening in your body when you work out. They’ll also administer spirometry tests before and after to get evidence that you have bronchoconstriction from exercise, Dr. Benzaquen says. Another diagnostic option is an inhalation test that stimulates the conditions that trigger exercise-induced asthma, according to the Mayo Clinic.

If you already know that you have asthma and it seems to get worse when you work out, your doctor might diagnose you without putting you through other testing, Khalid M. Eltawil, MD, a pulmonologist with Torrance Memorial Medical Center in Torrance, California, tells SELF.

Back to top

You don’t have to just suffer through exercise-induced bronchoconstriction—there are a few things you can do to keep your airways clear during workouts.

The most common treatment is using an inhaler for a set period of time before you exercise, Dr. Casciari says. The inhaler will contain medication to keep your lungs from going haywire, like a short-acting beta-agonist to open up your airways. Though it will depend on your specific prescribing information, you’ll typically use inhalers with short-acting beta antagonists 15 to 20 minutes before exercise, according to the Cleveland Clinic.

Usually, this kind of treatment does the trick, Dr. Benzaquen says. If you’re still struggling, your doctor might tack on a longer-term treatment in addition to the one you take before exercise. This might include daily medications like inhaled corticosteroids to help suppress inflammation in your airways, combination inhalers that contain a corticosteroid and a long-acting beta-agonist to prevent inflammation and relax your airways, or oral leukotriene modifiers to block inflammatory chemicals that can cause asthma symptoms, according to the Mayo Clinic.

Back to top

We can’t stress it enough: Working with your doctor to get properly diagnosed and treated is super important if you think you might have exercise-induced asthma.

It’s possible, that your exercise-induced bronchoconstriction could stay mild, Dr. Sindher says. For some individuals, the condition progressively worsens over time. “My worry is that symptoms would discourage folks from physical exercise, and that has lasting, long-term consequences,” she says.

If you don’t manage your asthma, you can also develop serious breathing difficulties over time. “If you’re an asthmatic and you have a lot of exercise-induced symptoms, it could put you at risk of having a full-blown flare of disease where you have to be on systemic steroids or be seen in an ER,” Dr. Chupp says.

Back to top

Exercise is an important part of promoting overall health—so chances are, figuring out asthma-safe ways to stay active is as important to your doctor as it is to you. “We want to make sure everyone is able to achieve their exercise goals,” says Dr. Sindher.

Also important: Research suggests exercise may actually improve asthma symptoms, so staying active could be a vital part of your treatment plan. According to Dr. Chupp, exercise maximizes airway function, opens your lungs, and requires you to use other parts of your lungs that you’re not using when you’re at rest. In other words, it makes your breathing more efficient, he says. “As your muscles train, you need to do less breathing when you exercise, so you can do more work with fewer breaths.”

While exercise-induced asthma can interfere with your ability to get through a workout, the right treatment plan can help you effectively manage asthma so that you can continue exercising at the level you want to, Dr. Sindher says.

Here are a few simple-but-effective tweaks you can make to your exercise routine.

Start with a warm-up and end with a cool-down: This can help your body become accustomed to the changes in airflow during exercise, Dr. Casciari says. Try to ease into your workouts by warming up for 10–15 minutes beforehand, doing activities that vary in intensity. Your health care team can help you figure out the best warm-up and cool down for you, depending on the severity of your asthma and your fitness level.

Protect yourself from cold, dry air: Even covering your mouth with something warm like a scarf when you’re outside can make a big difference, Dr. Pennington says. If cold temperatures trigger your exercise-induced asthma, and using an inhaler beforehand doesn’t help, talk to your doctor about other strategies. They may have other tricks, and if not, suggest switching to inside activities during the winter.

Breathe through your nose: Many people turn into mouth breathers when their heart starts pumping, but nose breathing will warm and humidify air more than your mouth will.

Avoid allergy-related asthma triggers as much as possible: This includes exercising outside when pollen is at its peak, resting if you’re sick since respiratory infections tax your airways, and avoiding chlorinated pools. If you have seasonal allergies to pollen or mold, check in with an allergist, who can recommend a treatment plan (such as antihistamines or allergy shots) that can help you exercise outside if you want to.

Try sports that require short bursts of energy: Sports that require ongoing physical exertion, like running long distances, endurance sports, or swimming cause you to breathe heavily without rest. On the flip side, sports that require shorter bursts of energy, like baseball or football, don’t tax your lungs as much. That said: With proper exercise asthma treatment, it’s absolutely possible to run long distances or play more demanding sports. The important thing is to know your triggers and listen to your body. “I’ve had Olympic athletes and marathon runners that are asthmatic,” Dr. Chupp says.

Practice deep breathing: Breathing exercises can improve your quality of life and reduce reliance on rescue medication⁴. Any exercise that emphasizes deep breathing—such as yoga—can be a great practice to start. According to Dr. Chupp, breathing exercises can also help open your airways and improve airflow, which could reduce your asthma symptoms⁵.

Basically, there are a lot of options out there that can help if you struggle with exercise-induced bronchoconstriction. Don’t just assume working out isn’t for you—talk to your doctor about a treatment plan that can help you get through exercise sessions instead of throwing in the towel. “There’s always more we can do to manage asthma to make sure everyone can achieve the level of exercise they want to accomplish,” Dr. Sindher says. 

Back to top

Sources:

1. European Respiratory Journal, Exercise Is Associated with Improved Asthma Control in Adults
2. StatPearls, Exercise-Induced Asthma
3. Asthma Research and Practice, Exercise-Induced Bronchoconstriction: New Evidence in Pathogenesis, Diagnosis, and Treatment
4. Breathe, Breathing Exercises for Asthma
5. Cochrane Library, Breathing Exercises for Adults with Asthma

Related:

• Here’s Exactly How to Create an Asthma Action Plan
• Understanding These Types of Asthma Can Help You Identify Your Triggers
• Here’s Why Your Asthma Gets Worse at Night