Breathing Room Even Top Athletes Grapple with Exercise-induced Asthma

To someone with exercise-induced asthma, the possibility of regular exercise and athletic competition can seem out of reach.

But it was no hindrance to former All-Pro running back Jerome Bettis or Basketball Hall of Fame center Hakeem Olajuwon, nor did it prevent track star Jackie Joyner-Kersee or swimmer Amy Van Dyken from collecting fistfuls of Olympic medals.

In fact, the American Academy of Allergy, Asthma and Immunology (AAAAI) estimates that about about 1 in 6 Olympians grapple with exercise-induced asthma (EIA), which causes one’s airways to narrow during physical exertion, making breathing difficult. Perhaps surprisingly, that’s slightly higher than the 13{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the general population suffering with EIA.

‘Suffering,’ though, is a relative term. The key, doctors say, is learning how to manage the condition.

“People with asthma will experience one of maybe two or three things, the most common being getting out of breath and tightening of the chest,” said Dr. Robert Kaslovsky, chief of the Pediatric Pulmonary Division at Baystate Children’s Hospital. “Sometimes they might have wheezing; sometimes they might cough. Exercise is a very common trigger, particularly in the cold air.”

That’s because, according to the AAAAI, people with exercise-induced asthma have airways that are overly sensitive to sudden changes in temperature and humidity. During physical exertion, people tend to breathe through their mouths, which — particularly in colder weather — draws cool, dry air directly into the lungs, bypassing the warmth and moisture produced by breathing through the nose.

This is why many swimmers do well with EIA, because they’re typically breathing warm, moist air. But with proper management of the condition, no sport is truly off limits.

Just Breathe

The symptoms of EIA are similar to those of chronic asthma, and typically include shortness of breath, tightness in the chest, coughing, wheezing, and, when untreated, decreased performance. Treatment is also similar to what’s prescribed for chronic asthma.

“In general, there are two therapies used for asthma: relievers and controllers,” Kaslovsky said. Relievers — also called rescue medications when used during an asthma attack — are typically albuterol inhalers, which help open up the airways. Athletes with EIA will typically use the inhaler 15 minutes before exercise, and during exercise if needed.

“Basically, people with exercise-induced asthma need to have an inhaler,” said Sam Headley, professor of clinical exercise physiology at Springfield College. “After being diagnosed by a physician, they should have an inhaler with them, and they should take the required number of puffs.”

Controller medications are steroid inhalers, which reduce inflammation in the lungs, said Kaslovsky, noting that Singulair taken orally works for some people as well. The inhaler is typically used about two hours before exercise, while Singulair is likely to be an everyday medication.

Dr. Elana Pearl Ben-Joseph, a pediatrician and researcher at Partners Healthcare, noted at kidshealth.org that “taking medication exactly as your doctor prescribes is the most important tip of all. Skipping controller medications can make symptoms worse. Forgetting to take medication before exercise can lead to severe flare-ups and even emergency-department visits.”

She also stressed keeping an inhaler on hand while exercising. “Though you may feel shy about your asthma, don’t try to hide it. Coaches especially should know about it so they will understand if you need to take a breather and use your medicine.”

A proper warmup is also important, Headley said, at least 10 to 15 minutes of stretching, jogging, or whatever else might be appropriate for the sport or activity in question. “We’ve learned over the years that it’s really important that people with asthma do a good warmup prior to exercise, even spend more time than the average person warming up.”

Is It Asthma?

Before any of that, however, a doctor needs to make sure he’s actually dealing with asthma, because several conditions can mimic its symptoms.

“Not everyone who is short of breath has exercise-induced asthma,” Kaslovsky said. “We also see vocal-cord dysfunction, a syndrome where the actual vocal cord at the tip of the airway, which is supposed to be completely open, actually closes when you’re exercising and trying to breathe harder. But that’s in no way asthma.”

He said some patients with this condition might go through three or four asthma medications — without relief, of course — before being properly diagnosed; sometimes a speech pathologist can help the patient control the vocal muscles, and if stress is determined to be a factor, a psychologist or even a hypnotist is occasionally beneficial, he explained.

Less-common, but also producing symptoms similar to exercise-induced asthma, is stress-related hyperventilation. “Particularly with really, really competitive athletes, they might get an adrenaline rush during competition and might not feel they’re getting enough air in their lungs, but nothing’s going on except hyperventilation,” Kaslovsky said. A sports psychologist or other counselor can be effective in dealing with this condition.

“These symptoms are more common than people realize, but they’re not always asthma,” he added. When they prove to be EIA, however, it’s good to know that there are remedies — even for athletes who aspire to greatness.