Exercise-Induced Asthma

Also called: EIA, Exercise-Induced Bronchoconstriction

What Is Exercise-Induced Asthma?

Many kids and teens with asthma have symptoms when they exercise if their asthma is not well-controlled. But some people have asthma symptoms only during or after exercise. This is called exercise-induced asthma (EIA). The asthma symptoms happen because the airways tighten up (called bronchoconstriction) during exercise. This blocks the flow of air and makes it hard to breathe.

What Are the Signs & Symptoms of EIA?

Someone with EIA may:

• have  wheezing , tightness or pain in the chest, coughing, or shortness of breath during or after exercise
• get winded or tired easily during or after exercise
• cough after coming inside from being active outdoors
• not be able to run for more than a few minutes without stopping

Kids with EIA might begin having symptoms 5–10 minutes after starting to exercise (though some kids only get them after they stop being active). Symptoms usually peak 5–10 minutes after stopping the activity and may take an hour or longer to end.

Of course, there's a difference between someone with exercise-induced asthma and someone who's out of shape and winded. It takes much longer for someone with EIA to recover. And temperature extremes — especially cold, dry weather — can make it even worse.

What Causes EIA?

Things that trigger symptoms during exercise can be different in different people. One common trigger is breathing in cold, dry air. It gets even worse during exercise because when kids exercise or play hard, they tend to breathe quickly, shallowly, and through the mouth. So the air reaching their lungs misses the warming and humidifying effects that happen when they breathe more slowly through the nose.

Sometimes people with EIA feel symptoms when the air is warm but polluted or full of pollen. Other people might get symptoms while swimming if they're sensitive to the chlorine fumes from the pool.

How Is EIA Diagnosed?

A doctor will ask about the family's asthma and allergy history and about the symptoms and what triggered them in the past. Often a doctor will suspect EIA if symptoms fit the typical pattern and clear up with the use of asthma medicine.

Sometimes a doctor may ask a child to take a breathing test after exercising. This can be done in the office on a treadmill, after the child runs outside for 6–8 minutes, or after the child does an activity that triggered flare-ups in the past.

How Is EIA Managed?

The most important way to manage EIA and prevent symptoms is to make sure that a child’s asthma is under control, even when they aren’t exercising. This means avoiding triggers and taking asthma medicines as prescribed.

When a person knows that exercise usually leads to asthma symptoms, a doctor will likely recommend that they take medicine before exercising or being very active. Two kinds of medicine are used to prevent asthma symptoms during exercise:

• bronchodilators: These work quickly to relax the muscles around the airways. When taken before exercise, they prevent the airway narrowing that it triggers. Bronchodilators also help to provide quick relief of symptoms whenever they happen. That's why they're sometimes called "quick-relief," "rescue," or "fast-acting" medicines.
• anti-inflammatory medicines: These work over time to ease inflammation in the airways. This helps to prevent swelling and excess mucus production, which can make the airways even narrower. A person usually needs to take these every day, even when they feel fine and have no symptoms. These are sometimes called "controller," "maintenance," or "long-term control" medicines. Some kids get anti-inflammatory medicines together with bronchodilators from one inhaler device, and can use this combination before exercise for symptom prevention.

If your child takes medicine before exercising but still has breathing trouble while being active, let the doctor know. They might recommend that your child take medicine every day, if they don’t already, or that medicine dosages be adjusted for better control.

Can Kids With EIA Still Exercise or Play Sports?

Exercise is a great idea for everyone, including people with exercise-induced asthma. Besides keeping kids and teens fit, exercise can improve lung function by strengthening the breathing muscles in the chest.

Encourage your child to be active while also keeping asthma symptoms under control by following the asthma action plan. When asthma is well-controlled, kids with asthma can do anything their peers can do. In fact, many Olympic athletes have EIA, which doesn’t stop them from doing their sport and winning medals.

Tips for kids and teens with EIA:

• Take the prescribed asthma medicine about 15–30 minutes before exercising.
• Warm up before exercise to prevent chest tightening. Warm-up exercises can include 5–10 minutes of walking or any other light activity, plus stretching or flexibility exercises.
• Breathe through the nose during exercise.
• Take short rest breaks if it's helpful.
• If symptoms start, slow down the exercising. If symptoms get worse, taking asthma medicine might help. Don’t try to “play through” symptoms — this can be dangerous and bring on a severe flare-up.
• Avoid exercising outside during very cold weather. When exercising in the cold, wearing a ski mask or a scarf over the mouth and nose can help.
• If air pollution or pollen are triggers, exercise indoors when air quality is poor or pollen counts are high.
• Cool down after exercise to help slow the change of air temperature in the lungs.

Kids should always have access to their asthma medicines. Keep extras on hand and be sure to check all supplies so your child isn't carrying an empty inhaler.