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Monday, February 22, 2010

Exercise Induced Bronchospasm

I was recently asked to write a post about exercise induced asthma and how it pertained to athletes, especially on how it effects athletes, how they can prepare for a workout, and how they can manage and live with it. From my research I learned there was much about EIA I didn't know.

Maybe I knew this before and had forgotten, but I didn't know that EIA and asthma triggered by the cold weather were one and the same. That EIA wasn't even considered a disease until the 1960s. That EIA is relatively a new diagnosis for asthma, and that EIA isn't even a good term for EIA, that EIB is a more appropriate acronym.

Read on, and you'll be amazed as I was on what you'll learn.
Exercise- Induced Asthma Troubles Many -- Even Olympians
by Rick Frea, Monday, February 08, 2010, @
MyAsthmaCentral.com

If you have asthma, chances are you have exercise induced asthma (EIA). I was actually a bit shocked as I read this post and learned that of the 18 million Americans with asthma, 80-90 percent have EIA.

What I also found stunning was that this article from the New York Times noted half of all cross country skiers, and 17 percent of Olympic-level distance runners, have been diagnosed with EIA. Likewise, according to the American Academy of Allergy, Asthma and Immunology (AAAAI.org), 23 percent of all Olympians have EIA.

I have EIA, and chances are you do too if you've ever experienced the following symptoms during or 5-15 minutes after exercise:

  • Wheezing
  • Tight chest
  • Cough
  • Shortness of breath
  • fatigue
  • Chest pain (rarely)
  • cough (perhaps due to increased mucus production)
  • When these symptoms occur they can be treated with your rescue inhaler (like Albuterol) and rest. Although, with proper diagnosis and treatment, these symptoms can be controlled so you can exercise as normal.

    Yet, before we get into diagnosis and treatment, let's describe EIA.

    The best definition I could find came from this post at AAAAI.org, which notes exercise doesn't necessarily "cause" asthma, but that "hyperventilation (fast breathing) associated with exercise cools and dries the upper and lower airway resulting in the release of histamine and other substances that produce the bronchospasm (spasming of the muscles in the air passages in your lungs)."

    Likewise, when an asthmatic exercises when the temperature is cold, and the air dry, "Hyperventilation of cold dry air produces a similar response."

    In this way, asthmatics are more likely to have asthma symptoms when they exercise in cold, dry air.

    Dr. Randolph also said it isn't so much the cold weather that triggers the asthma attack, but the fact that the air is dry. Asthmatic lungs have a diminished ability to humidify the air, and this triggers the asthma response. This has been proven via various studies.

    AAAAI.org also notes it doesn't help that "During strenuous activity, people tend to breathe through their mouths, allowing the cold, dry air to reach the lower airways without passing through the warming, humidifying effect of the nose."

    Actually, according to Dr. Christopher Randolph, a clinical professor at Yale University who was interviewed by The New York Time's, EIA is not quite the same as asthma. He notes the "'preferred term' in the scientific community for exercise-induced asthma is exercise-induced bronchoconstriction, or EIB.

    Thus, 13 percent of the non-asthmatic community has EIA, and up to 40 percent of those with a history of allergic rhinitis and allergies, the AAAA.org notes.

    So, why is it that so many athletes have EIA?

    One theory proposes that, according Dr. Randolph, "elite endurance athletes, especially those training more than 20 hours a week, actually 'injure their airways' by breathing so much and so hard. 'They take in up to 200 liters of air per minute,' he says, in comparison to perhaps five or six liters per minute at rest, all of which must be humidified."

    The article further notes the following fact:

    "The resulting inflammation within their bronchial tubes becomes chronic over time, and each subsequent workout more easily triggers a new EIB episode. Cross-country skiers, runners, cyclists and other athletes who train in the wintertime may not have been born with breathing problems, but their repeated episodes of hyperventilating in cold air induce the malady."

    Other things that might effect EIA are:

    • Air pollution
    • High pollen levels
    • Viral respiratory infections
    • Being out of shape
    • poorly controlled allergies/asthma

    Now for the diagnosis and treatment.

    If you suspect you have EIA, you'll want to talk to your doctor and get a proper diagnosis. This can be done by you describing your symptoms, or by your doctor having you do an exercise challenge test. Here you run on a treadmill and have spirometry testing done before and after you work out

    There are two ways to treat EIA. Which one works best for you is generally determined by trial and error:

    1. You'll take asthma controller medications like Advair and Singulair every day.

    2. You'll pre-treat yourself before exercise. There are different methods of pretreating, some of which include taking:

    • 2-4 puffs of Albuterol with a spacer 5-30 minutes before exercise
    • 10 mg of Singulair two hours before exercise.

    Other ways to treat EIA are to:

    • Slowly warm up before exercising for 5-15 minutes
    • Wear a mask in cold weather (or a scarf) to recirculate the air you breath to moisten your airway.
    • Try to breath through your nose
    • Work out indoors when the weather is cold
    • Work out indoors when pollution levels are high
    • Work out indoors when pollen counts are high (like in the Spring)
    • Don't work out when you have a cold
    • Pace yourself
    • Regular exercise training
    • Be compliant with your asthma meds

    AAAAI.org lists alternate activities to consider, such as swimming (you're breathing in moist air as you work out), walking, biking, hiking, or team sports that require "short bursts of energy", such as baseball, football, or short-term track and field.

    Doctors may recommend Olympians cut back on their training in cold weather to minimize their EIA, and this may work for you too. Yet, as many Olympians will prove in the Winter Games that take place February 12-28, 2010, EIA should never stop you from exercising.