Whole Health

Does exercise literally take your breath away? You’re not alone. You may be one of the many suffering from undiagnosed exercise-induced asthma.

You work out regularly and are at a healthy weight. A 10-mile bike ride or 20 laps in the pool have you barely breathing hard. But after a 20-minute jog, you find yourself literally gasping for air. Maybe running’s just not your sport.

No need to give up your triathlon dreams yet. You may actually be suffering from exercise-induced asthma (EIA) or bronchospasm (EIB), a narrowing of the airway resulting from muscle constriction and tissue inflammation. The condition occurs when a high volume of dry air moves rapidly in and out of the lungs over a continuous period, which is why some activities are more likely than others to bring on an episode.

While the vast majority of people with chronic asthma (those whose attacks are triggered by viral infections, allergies, or other factors) experience EIA, an estimated 10 to 15 percent of nonasthmatics also develop symptoms, such as wheezing, chest tightening, coughing, or fatigue, only during exercise. Elite athletes have even higher prevalence rates—some studies have found greater than 40 percent—because of their much higher ventilation rates.

“That’s why many experts now distinguish between EIA and EIB,” says Jonathan Parsons, MD, associate director of the Ohio State University Asthma Center in Columbus, “since the latter term is more fitting for those people who exhibit no other features of asthma.”

Researchers haven’t found a good explanation yet as to why some people experience EIB while others don’t. It begins in childhood and continues throughout a person’s life, and it affects men and women more or less equally.

But because many of the symptoms may be mistaken simply for poor conditioning, EIB often goes undiagnosed. (Wheezing, which is probably the most widely recognized symptom of asthma, doesn’t always occur.) The unfortunate result is that many sufferers end up unnecessarily avoiding the activities that bring on these symptoms—or reducing the level of intensity to a point where they are not performing as well as they could be or not gaining the maximum health benefits.

So how do you know if you have EIB? “A subjective description of symptoms alone is not sufficient,” says Dr. Parsons, “because the same symptoms can also indicate several other conditions, including vocal cord dysfunction, severe acid reflux, and certain cardiac disorders.” After conducting a study on the prevalence of EIB in varsity athletes, published in 2007 in Medicine & Science in Sports & Exercise, Dr. Parsons notes, “If we had given an albuterol inhaler empirically to every athlete who complained of symptoms when they exercised, we would have been correct only about 35 percent of the time.” Accurate diagnosis, therefore, depends on objective measurement of the patient’s lung function.

The most common test involves blowing into a device called a spirometer, which measures the volume of air being exhaled. The doctor first does a baseline test to measure normal lung function. Then the patient runs on a treadmill for several minutes, after which the output is measured again. A 10 percent decline from the baseline indicates EIB.

The good news is, once an EIB diagnosis has been confirmed, the condition is easily managed. The most effective preventive treatment is to take two puffs of an inhaler with albuterol, a short-acting bronchodilator, about 10 to 15 minutes before beginning exercise, and then do a vigorous warm-up that gets the heart and breathing rates up.

“For example, if they are going to play a soccer game, we don’t want them to get out of their car and run onto the soccer field and start playing,” says Dr. Parsons. “We’d like them to warm up for about 10 or 15 minutes—get a little bit of a sweat going. The combination of warm-up and albuterol is effective in a vast majority of people with this problem.”

Another proven strategy for reducing the frequency and the severity of attacks is to improve your overall physical conditioning, says Elliot Israel, MD, associate professor of medicine at Harvard Medical School and director of clinical research in the pulmonary division at Brigham and Women’s Hospital in Boston. “If you are in bad shape, and you run a mile and you’re just huffing and puffing and huffing and puffing—remember, it’s the huff and puff that gives you the exercise-induced bronchospasm. So if you’re in better shape, you don’t need to ventilate as much.”

Choosing different activities can also have an impact. A sport like cross-country skiing, where you’re breathing in cold, dry air over an extended period of time, is more likely to trigger an attack than is swimming, where the air is moist and warm, or rock climbing, where you can stop periodically to catch your breath. It’s not always that cut and dried, however, adds Dr. Israel. For example, swimming in a pool that is highly chlorinated in a poorly ventilated facility may still cause problems because the chemicals can irritate the lung tissues, making them more “twitchy” and therefore more susceptible to bronchospasm. Air pollution has a similar effect, so doctors recommend that EIB sufferers exercise indoors on smoggy days.

Whatever your sport of choice, the important thing is to recognize any symptoms that might indicate EIB and then get tested. With proper diagnosis and treatment, you’ll soon be able to breathe new life into your favorite activities.

Eat Your Way to Better Breathing

“Anything to reduce the reliance on pharmacological medication is a good thing,” says Timothy Mickleborough, PhD, associate professor in the department of kinesiology at Indiana University in Bloomington and co-author of several studies on the impact of various dietary factors on EIB.

Taking the right supplements and eating the right foods can actually help you breathe easier.

Salt intake. “High-salt diets are definitely responsible for increased severity,” says Dr. Mickleborough. He adds, however, that using sports drinks like Gatorade during exercise is not a problem.

Fish oil. In two different studies, one with elite athletes and another with chronic asthmatics, adding fish-oil supplements to their diets over a three-week period resulted in a dramatic improvement—80 percent for the athletes—in lung function.

Vitamin C. Recent research suggests that increasing this antioxidant has similar benefits to adding fish oil. Good sources of vitamin C include citrus fruits, strawberries, bell peppers, and broccoli.