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Take Your Breath Away: The Facts About Exercise-Induced Asthma

By Russ Klettke

People who have asthma generally know it. Either it’s something they have had since childhood or they’ve had it diagnosed as adults. If that’s you, you probably recognize the triggers and symptoms—a constriction of the throat or chest that restricts breathing—and have an inhaler handy at all times.

But what if an asthma episode happens to you on rare occasions? You may not even know what it is, just a momentary panic over the fact your windpipe or chest has tightened and it’s hard to catch your breath. This sometimes happens to people who exercise in cold weather, but exercise-induced asthma can also happen on hot, muggy days. It’s even possible to have an asthma attack during sex.

Fortunately, there are things you can do in either situation. And because psychological factors can play into it—panicking can make it worse—it helps to give this some thought, even if you’ve never (yet) experienced exercise-induced asthma.

You're Hot and You're Cold
There are several triggers to asthma. Asthma is often associated with allergies and the symptoms of both often coincide. For example, cat dander, dust and pollen can trigger both. But at any age, there are three other key factors that make it more likely you will have asthma: genetics/family history, cohabitating with a smoker and living in urban areas.

Asthma that is diagnosed happens in degrees, from mild to severe. In the worst cases it can be life limiting. The most common treatments are anti-inflammatory medications (e.g., inhaled steroids, used daily) and bronchodilators (used during episodes). Yet the people with a diagnosis in some respects are lucky. They know the triggers, they know how to respond and they have medications at the ready. But athletes with no history can undergo some anxious moments—and not know what to do—if they have an attack.

I know. It happened to me during the Chicago Triathlon of 2010. In 93 degrees and relative high humidity, it was one of the hottest races I had run in my 20+ years of competing. The attack was mild and I only noticed it at the finish of the race, but the wheezing was a little disconcerting. It passed in about a minute, but I was told the medical tent saw a number of people experiencing the same thing. So, what happened? Asthma can be caused by higher ozone levels in the air, which makes sense given the race was in downtown Chicago. Exercise forced this athlete to take in more of that bad air, increasing the likelihood of an attack.

A study published in the Journal of Asthma (“Airway inflammation in exercise-induced bronchospasm occurring in athletes without asthma,” Parsons JP, Baran CP, et al., June 2008) looked at 96 athletes who did not have asthma per sé. The study found that some athletes have higher levels of inflammation in their airway passages, and those individuals have a greater propensity toward exercise-induced bronchospasm (EIB, the technical name for exercise-induced asthma). In other words, there are some of us who are predisposed to such occasional attacks, but who are not full asthmatics.

The trigger of an exercise-related asthma attack, unlike with my Chicago triathlon experience, is more typically cold, dry air. The nose is supposed to warm and moisten the air before it makes its way to the lungs. But when you exercise you tend to breath through the mouth, which reduces the warming, wetting effect of air going through the nasal passages. Other causes are air pollution, high pollen counts, airborne chemicals (chlorine, paint, herbicides and fertilizers) and respiratory infections such as a cold or flu.

What should the undiagnosed athlete do if faced with EIB? According to the American Academy of Allergy, Asthma & Immunology, such an individual should slow down and stop the activity, sip water, alert another person to your symptoms and determine if you need to call emergency medical services (9-1-1) if your breathing remains labored. After that, you need to see a physician, in particular an allergist, to determine if you need to address it proactively with medication.

Exercise-induced asthma generally dissipates in a minute or two. But it may be the first symptom of a progressing condition, particularly for someone who is increasingly exposed to environmental triggers. This is further reason to see a doctor about it. Medications will not slow the disease’s progression but can keep symptoms at bay, according to a 2002 report from the National Asthma Education Program.

Talk About a Mood Killer...
Alas, if you’re an athlete in bed you stand the risk of exercise-induced asthma just as much as a snowboarder. It could happen from the activity (Windows open on a high-ozone summer day? Crazy black diamond run spontaneity at Gay Ski Week?), something in the bedding (dust, for example) or even latex condoms, for people who have latex allergies.

Paul Selecky, MD, who is medical director of the pulmonary department at Hoag Memorial Hospital in Orange County, California, told WebMD there are several things you can do to minimize the likelihood of this happening in flagrante delicto if you have occasional or chronic asthma:

  1. Be more passive. Aggression requires more breathing, and that can lead to inhaling the attack triggers.
  2. Adopt positions that place less pressure on the lungs. Challenge: to still be passive, as just noted—to fully explain this would require diagrams, so you’ll need to use your sense of inventiveness.
  3. Midday sex is best for those who take medication. In the morning you may not yet have taken yours and in the evening it may have worn off.
Back to being vertical and clothed, if you get occasional exercise-induced episodes of constricted breathing, the key points to remember are to drink water frequently, warm up and cool down appropriately, and beware of temperature extremes and high ozone levels.

About Russ Klettke: Russ Klettke is an ACE (American Council on Exercise) certified fitness trainer and also the author of “A Guy’s Gotta Eat, the regular guy’s guide to eating smart” (Marlowe & Co., 2004, with Deanna Conte, MS RD LD), available where books are sold and in more than 100 public library systems in the U.S., Canada and Europe. For more information, see http://RussKlettke.com.