Heavy Breathing

Do you experience wheezing, coughing, shortness of breath and excessive chest congestion and tightness during or after exercise? If so, you may have exercise induced asthma (EIA). I have had a formal diagnosis of EIA since 1993. As a swimmer, the asthma episodes were sporadic and explained away as working really hard. Once I started running, it was quickly apparent that something was amiss. I remember early in my running career huffing up a steep hill and being greeted with freshly cut grass at the top. I was hunched over, scared and unable to breath. Thus began my education, frustration, and sometimes denial about EIA. Daily medications remind me that EIA is serious; workouts are sometimes hampered and I have dropped out of numerous races.

As the years have progressed, I have become increasingly exasperated when I hear or read comments alluding to the notion that athletes claim to have asthma so they can have access to the various medicines. Asthma is no joke and those that suffer from it can attest to that. The medicines prescribed for asthma do not have performance enhancing characteristics and the World Anti-Doping Agency has finally recognized this and no longer requires asthmatics to jump through hoops to get their necessary medications.

Believe it or not, asthma occurs in over 20% of Olympic athletes (with up to a whopping 50% of biathletes) and 12-15% of the general population. However, athletes with EIA can successfully compete at the highest level, with appropriate diagnosis and treatment. Wheezing, coughing, chest tightness and sputum production are the classic symptoms of asthma, and there are four categories of triggers that can set any one of these symptoms off: allergy-causing materials (pollens, danders and molds); irritants (tobacco smoke and pollution); viral infections (the simple cold); and for me and many of you, exercise. Medical professionals theorize that exercise-induced asthma is due to the cooling and dehydration of our lungs that occurs with the more rapid breathing that we experience during training and racing, especially during harder workouts (http://www.lungusa.org/asthma).

Asthma that is left untreated, under-treated or uncontrolled (due to the common cold or the increase in exposure to environmental allergens or pollution at certain times of the year) can hinder your ability to train and race. Over the years, I have had several experiences which remind me that even with advances in medication and education on how to properly administer inhalers, EIA represents a major challenge.

The occurrence and extent of EIA depends on type of exercise. Vigorous running is the most likely type to induce symptoms — jogging and biking are less likely to do so, while swimming is usually the least likely. Exercise-induced asthma symptoms typically start 5-10 minutes after an activity is completed, but for many of us who extend our bodies and lungs past usual limits, such symptoms can and often occur during hard workouts and competitions. Symptoms usually lessen with rest, but can persist for more than an hour after exercise is completed.

EIA can be prevented most of the time. Unfortunately, no regimen works all the time; respiratory illness, extremely cold weather, and high ozone levels affect my asthma negatively no matter how much medicine I use. Treatments should be individualized to the particular athlete and the specific competition. Most importantly, prevention of EIA relies on treatment prior to exercise with appropriate medications and compliance. Management of asthma symptoms during a workout requires early recognition that they are developing and then prompt treatment with bronchodilators. Do not feel shame in stopping your workout to “catch your breath.” I do it often.

Please explore these web sites for detailed information concerning exercise-induced asthma:

After reading this summary, should you feel that you may have exercise-induced asthma or that it is not being controlled adequately, please seek assistance from a qualified allergist or asthma specialist to obtain individualized treatment. It is important that a physician confirm a diagnosis of exercise induced asthma with appropriate breathing tests to avoid inappropriate treatments. One should be aware that certain other disorders, such as cardiac conditions, can mimic asthma by leading to chest symptoms that feel somewhat like asthma. Moreover, conditions like gastrointestinal reflux (severe heart burn) can trigger asthma. Even emotional events can affect asthma control in some individuals, though such factors are not the cause for asthma.

Here are some tips from the American Academy of Allergy, Asthma & Immunology to mitigate exercise induced asthma symptoms:

  • Keep allergies and asthma under control – Follow treatment plans as recommended by your allergist/immunologist.
  • Warm-up – Start your workout with stretches or other light activity.
  • Stay hydrated – Drink plenty of water before, during and after exercise.
  • Exercise indoors – Keep your workout in the gym on days when temperatures are extremely hot or cold, the air is dry or pollution levels are high. When exercising outdoors on cold days, a scarf over your mouth and nose can help warm inhaled air.

And here are some tips from me:

  • Always carry your inhaler with you – Nothing is worse than having symptoms without your rescue medicine.
  • Use a Peak flow meter – A peak flow meter is a device that will allow you test your lung function and determine whether your treatment is working.
  • Check the pollen and pollution – I constantly look up the conditions for my area to lessen any surprises. I get email alerts when the ozone or particulate matter is high.
  • Prime your inhaler – If you have a new inhaler or an inhaler that has not been used in a few weeks, activate the inhaler by spraying it 4 times.
  • Check the expiration date — The inhaler you picked up you two years ago is not good enough. Get a new one.
  • Know how to use your inhaler — Breathe out fully before using your inhaler. Place the mouthpiece in your mouth and inhale slowly as you press down. Hold your breath for about 10 seconds and then breathe out. Wait one minute before taking another “puff” if your doctor recommends more than one. Clean your mouthpiece and the area where the medicine is dispensed in warm water at least once a week, gunk builds up preventing proper flow.

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5 Responses

  1. Nico says:

    Having been recently diagnosed, I have to thank you for this very informative article!

  2. Burke says:

    Thanks so much for the great info. Your own tips are especially helpful…things I hadn't really considered. I suffer from adult-onset asthma that has gotten worse since moving to Boulder. The cottonwoods, summer hay and Boulder Rez's cold water make triathlons here a real challenge for me.

  3. Rikki says:

    First off – just discovered your website, this is wonderful. I wanted to add some nutritional insight to EIA: omega 3 fatty acids and vitamin D (check your levels) would be worth discussing with your health care provider or a certified sports dietitian. Both have research behind them for improvement with EIA re: lung function and enhancing treatment (note: not replacing).
    Both nutrients work to reduce inflammatory compounds in the body and are linked to immune system. Caffeine may also help some folks with asthma, however as with anything too much can negatively effect performance. Personally, I love my FRS drink right before a swim, has small amt of caffeine – very individual though.

  4. Jennifer says:

    I just started triathlon and had a full-blown asthma attack for the first time in my life after my first race. I also train in northern Cal where the water is 55 degrees and it totally constricts my lungs. Do you bring your inhaler in your wetsuit? (is it waterproof?) Where's a good place to put it? Thanks for this post, very informative.

  5. Doug K says:

    thank you, this is all excellent advice. I discovered most of it through making my own mistakes unfortunately 😉

    I'd second the omega3/fish oil recommendation. Since taking that regularly, my EIA has been much relieved.