You’re out for a nice fall run, but 5 minutes into it, you’re coughing and can’t catch your breath. Is this just what it feels like to be out of shape? Is it allergies? Maybe and maybe. But it could also be exercise-induced bronchoconstriction (EIB), aka exercise-induced asthma.
Does EIB mean you have to throw in the towel and park yourself on the couch? Heck no! In fact, with the right treatment, people with EIB can be as active as they want. Lots of elite athletes have asthma or EIB.
Coughing is the most common symptom of EIB, and sometimes it’s the only symptom. You may also experience:
- shortness of breath
- tightness in your chest
- decreased endurance
- upset stomach
- sore throat
Symptoms usually start several minutes into a workout and are most severe 3 to 15 minutes after stopping. Breathing usually returns to normal about 20 to 30 minutes after that. It’s possible to have a second wave of symptoms over the next 4 to 12 hours.
Talk to a doctor if any of these symptoms interferes with your ability to exercise. There are medications and ways to modify your workout so airflow isn’t an issue.
Breathlessness from exercise isn’t a mystery: your body works hard, it needs more oxygen, you breathe harder to get that O2. EIB is different because your airway actually starts to constrict, making it harder for the air to get into your lungs. Weird, right?
If you have EIB, rapid breathing through your mouth introduces more cold, dry air into your airway, triggering the constriction.
That’s why you may find symptoms are worse on cold days or in dry conditions. Other triggers like pollution, pollen, smoke, fumes, or a recent respiratory infection or asthma attack may also make an episode of EIB more likely.
Researchers estimate that 40 to 90 percent of people with chronic asthma also experience EIB. Between 8 and 20 percent of people without asthma have symptoms of EIB.
Elite athletes are at increased risk of EIB because their participation in sports requires a lot of time inhaling cold, dry air and pollutants. Children also seem to be at higher risk of EIB than adults.
Episodes of EIB can cause temporary inflammation and damage to lungs, but it’s reversible with proper treatment. The biggest complication associated with exercise-induced breathing difficulty is… GIVING UP ON EXERCISE!
Some people with EIB feel anxiety, fear, and embarrassment about exercising. Rightfully so! What’s not scary about feeling like you can’t breathe?
The truth is avoiding exercise is counterproductive. It’s totally possible to have an active life while managing EIB. (Remember those elite athletes? They don’t get to the Olympics by giving up.) In fact, exercise improves quality of life.
The most common way to diagnose EIB is by measuring lung function before, during, and after exercise.
A person is diagnosed with EIB if their forced exhale volume in 1 second is reduced 10 to 5 percent after exercise. Forced exhale volume is measured with a spirometer, a device that you breathe into.
Normal lung function test
Your doctor may use spirometry (that tube you breathe into) to measure how much air you can exhale forcefully and quickly. If you’re not experiencing symptoms or haven’t been exercising before the test, results will likely be normal.
Exercise challenge test
To get a full picture of the impact of exercise on your breathing function, the doctor will do a bronchoprovocation test. Sound provocative? It just means they’ll measure the volume of air you exhale at rest, during exercise, and after exercise.
For this test you may use a treadmill, a stationary bicycle, or recreate the exercise that caused your symptoms before.
Ruling out other possibilities
You may be tested again after using a bronchodilator like an albuterol inhaler. If the inhaler doesn’t improve symptoms, you might have exercise-induced vocal cord dysfunction instead of EIB. Vocal cord dysfunction symptoms will also stop as soon as exercise is stopped.
Bronchial hyperresponsiveness can also mimic EIB when the airways “overreact” to inhaling allergens or airborne irritants, causing cough and phlegm production.
There are a number of prescription medications that can help control exercise-induced asthma. Here’s your cheat sheet for medication options.
Take these before hitting the gym
- Short acting beta agonist or bronchodilator: Using this inhaler 10 to 15 minutes before exercise can prevent symptoms. It can also be used to treat symptoms after they occur.
- Long-acting bronchodilator: Inhaled 30 to 60 minutes before exercise, it prevents symptoms for 10 to 12 hours but offers no rescue benefit once symptoms occur.
- Mast cell stabilizers: Taken 15 to 20 minutes before exercise to prevent EIB.
An Inhaler for the long haul
- Inhaled corticosteroids: Taken daily for long-term treatment of asthma.
More tricks for preventing the wheeze
Try these recommendations to reduce your risk of EIB while exercising:
- Cover your mouth and nose with a scarf or mask during exercise so the air entering your lungs is warmer and more humid.
- Warm up for 5 to 10 minutes before the main workout. (This helps more than 50 percent of people with EIB.)
- Try to breathe through your nose. Your nose is great at converting air to the best temp and moisture for your lungs.
- In a study of 64 asthmatic children, positive pressure treatment (CPAP and BIPAP) reduced EIB and lung inflammation.
You don’t want to mess around when it comes to breathing. Follow your doctor’s recommended treatment for EIB, but you may find some of these alternative therapies are helpful too.
- Caffeine before exercise may help prevent airway constriction.
- The American Thoracic Society says a low salt diet and taking fish oil and vitamin C supplements may help.
- Breathing exercises and yoga may improve symptoms or at least decrease the anxiety and depression people with EIB feel.
Like we said, even if you have EIB, you can totally get your exercise on. However, some forms of exercise are better than others for people with exercise-induced asthma.
You might have worse symptoms exercising in the cold (think ice hockey, skiing, snowboarding, snowshoeing). EIB symptoms are also more likely with sports that require sustained activity like long distance running and soccer.
Choose exercise that’s leisurely or requires short bursts of activity like:
When you experience symptoms that may be exercise-induced asthma, make a note of the temperature, where you were, what kind of activity you were doing. Also record your symptoms and approximately when they started and stopped.
All that information will give the doctor clues about whether it’s EIB. Also let them know if you’ve ever been diagnosed with asthma or have recently had any illness that could be related to your symptoms. Since your doctor may conduct an exercise challenge, dress for breaking a sweat.
While you might expect to be a little (or a lot) breathless during your workout, exercise-induced bronchoconstriction (EIB) can put a real cramp in your exercise plans.
Watch for coughing or wheezing that starts a few minutes into your workout and gets worse after you stop. A doctor can use lung function tests to confirm whether it’s EIB and prescribe inhalers or daily medications for prevention and treatment.
The most important thing to remember with EIB is for your physical and mental health, keep exercising!