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Exercise-induced bronchoconstriction

Wheezing - exercise-induced; Reactive airway disease - exercise; Exercise-induced asthma

Sometimes exercise triggers asthma symptoms. This is called exercise-induced bronchoconstriction (EIB). In the past this was a called exercise-induced asthma. Exercise does not cause asthma, but it can cause airways to constrict (narrow). Most people with asthma have EIB, but not everyone with EIB has asthma.

The symptoms of EIB are coughing, wheezing, a feeling of tightness in your chest, or shortness of breath. Most times, these symptoms start soon after you stop exercising. Some people may have symptoms after they start exercising.

Be Careful Where and When you Exercise

Having asthma symptoms when you exercise does not mean you cannot or should not exercise. But be aware of your EIB triggers.

Cold or dry air may trigger asthma symptoms. If you do exercise in cold or dry air:

  • Breathe through your nose.
  • Wear a scarf or mask over your mouth.

Do not exercise when the air is polluted. Avoid exercising near fields or lawns that have just been mowed.

Warm up before you exercise, and cool down afterward:

  • To warm up, walk or do your exercise activity slowly before you speed up.
  • The longer you warm up, the better.
  • To cool down, walk or do your exercise activity slowly for several minutes.

Some kinds of exercise may be less likely to trigger asthma symptoms than others.

  • Swimming is a good sport for people with EIB. The warm, moist air helps keep asthma symptoms away.
  • Football, baseball, and other sports with periods when you do not move fast are less likely to trigger your asthma symptoms.

Activities that keep you moving fast all the time are more likely to trigger asthma symptoms, such as running, basketball, or soccer.

Use Your Asthma Medicine Before you Exercise

Take your short-acting, or quick-relief, inhaled medicines before you exercise.

  • Take them 10 to 15 minutes before exercise.
  • They can help for up to 4 hours.

Long-acting, inhaled medicines may also help.

  • Use them at least 30 minutes before exercise.
  • They can help for up to 12 hours. Children can take this medicine before school, and it will help for the whole day.
  • Be aware that using this kind of medicine every day before exercise will make it less effective over time.

Follow your health care provider's advice on which medicines to use and when.

References

Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.

Nowak RM, Tokarski GF. Asthma. In: Walla RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 63.

Secasanu VP, Parsons JP. Exercise-induced bronchoconstriction. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 13.

Weiler JM, Brannan JD, Randolph CC, et al. Exercise-induced bronchoconstriction update - 2016. J Allergy Clin Immunol. 2016;138(5):1292-1295.e36. PMID: 27665489 ncbi.nlm.nih.gov/pubmed/27665489/.

  • What causes wheezing?

    Animation

  •  

    What causes wheezing? - Animation

    Wheezing can be a normal healthy response to an unhealthy environment. Or, wheezing can be a sign of asthma. I'm Dr. Alan Greene and I want to talk with you for a moment about how to tell the difference, what causes wheezing anyway, and when is it healthy and when is it not. Well to understand that, first let's all take a deep breath together (inhales). When you breathe in, the air comes through your nose or mouth, through the big windpipe and breaks into 2 big bronchi, one into each lung. And from there they break into a whole bunch of little, smaller bronchioles. It's almost like a tree's branches branching out. And those bronchioles are where the wheezing happens. Let's look at a bronchiole. Here's one of those small airways. Now if you happen to walk into a cloud of something that's toxic, your body is going to respond instantly to try to protect you. The first thing that will happen is the muscles around the bronchioles will tighten, will constrict down almost like a boa constrictor, and you get the tight airways. If that toxic cloud is still there, to protect your delicate tissues deep in your lungs, swelling of the lining will happen. Inflammatory stuff to help protect you from those toxins. And if it's still there, still irritating, mucus will begin to be secreted to be able again to capture and protect you from those toxins. That's wheezing. Asthma happens when your airways are hyper-responsive. When they're twitchy. When they're hyper-alert and they respond to something that's not truly dangerous. The problem with that is when your bronchioles are constricted and swollen and has mucus in them, that narrow little opening is hard to breathe through. You have to work to breathe, especially to breath out. And that hard breathing through a narrow passageway is what creates the sound we know as wheezing.

  • Asthma

    Animation

  •  

    Asthma - Animation

    Breathing is something we do without even thinking about it. But some people have a hard time breathing easily. They wheeze, cough, and just can't get enough air into their lungs. Let's talk about asthma. Normally when you breathe, oxygen-rich air enters your nose and mouth and travels to the airways in your lungs. But when you have an asthma attack, the muscles in your airways tighten. Your airways swell up and get narrower. It's like pressing on a straw when you're trying to drink through it. The more you press, the less of your drink can squeeze up through the straw. In the same way, less air can squeeze through tight airways into your lungs. So, what causes asthma? People with asthma have different triggers. Some people are sensitive to pet hair or dander. Others find that dust, pollen, smoke, or chemicals make them wheeze. You may have trouble breathing when you're under stress or working out at the gym. Often people with asthma have allergies that trigger their attacks. Others have a parent or other relative who has allergies. You may ask, how can you know for sure that you have asthma? During an asthma attack, you'll have trouble breathing. You may cough or wheeze as you try to draw air into your lungs. If you're having a severe attack, your lips and face may turn blue and you'll have a hard time getting any air. That's when it's time to call for emergency help. Your doctor will listen to your lungs with a stethoscope, and may do other tests to check your blood and lung function. To find out what's triggering your asthma, you may need to be tested for allergies to mold, pollen, pet dander, or other substances. To measure the strength of air flowing out of your lungs, you'll blow into a device called a peak flow meter. You can also use a peak flow meter to make sure you're keeping your asthma under control. Different medicines are used to prevent and treat asthma. Control drugs help you avoid asthma attacks, but you need to take them every day for them to work. You breathe in control drugs like Flovent, Singulair, and Pulmicort through an inhaler. If you're having an asthma attack, you can take a quick-relief drug to control your wheezing. Examples of quick-relief drugs include short-acting inhaled drugs and steroid medicines that you take by mouth. When you have asthma, you need to be prepared. Know your asthma triggers and try to avoid them. Carry an inhaler with you in case you have an asthma attack. If you ever have an attack that's so severe you can't breathe, call 911 or get emergency medical help.

  • Exercise-induced asthma

    Exercise-induced asthma - illustration

    Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. People who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.

    Exercise-induced asthma

    illustration

  • What causes wheezing?

    Animation

  •  

    What causes wheezing? - Animation

    Wheezing can be a normal healthy response to an unhealthy environment. Or, wheezing can be a sign of asthma. I'm Dr. Alan Greene and I want to talk with you for a moment about how to tell the difference, what causes wheezing anyway, and when is it healthy and when is it not. Well to understand that, first let's all take a deep breath together (inhales). When you breathe in, the air comes through your nose or mouth, through the big windpipe and breaks into 2 big bronchi, one into each lung. And from there they break into a whole bunch of little, smaller bronchioles. It's almost like a tree's branches branching out. And those bronchioles are where the wheezing happens. Let's look at a bronchiole. Here's one of those small airways. Now if you happen to walk into a cloud of something that's toxic, your body is going to respond instantly to try to protect you. The first thing that will happen is the muscles around the bronchioles will tighten, will constrict down almost like a boa constrictor, and you get the tight airways. If that toxic cloud is still there, to protect your delicate tissues deep in your lungs, swelling of the lining will happen. Inflammatory stuff to help protect you from those toxins. And if it's still there, still irritating, mucus will begin to be secreted to be able again to capture and protect you from those toxins. That's wheezing. Asthma happens when your airways are hyper-responsive. When they're twitchy. When they're hyper-alert and they respond to something that's not truly dangerous. The problem with that is when your bronchioles are constricted and swollen and has mucus in them, that narrow little opening is hard to breathe through. You have to work to breathe, especially to breath out. And that hard breathing through a narrow passageway is what creates the sound we know as wheezing.

  • Asthma

    Animation

  •  

    Asthma - Animation

    Breathing is something we do without even thinking about it. But some people have a hard time breathing easily. They wheeze, cough, and just can't get enough air into their lungs. Let's talk about asthma. Normally when you breathe, oxygen-rich air enters your nose and mouth and travels to the airways in your lungs. But when you have an asthma attack, the muscles in your airways tighten. Your airways swell up and get narrower. It's like pressing on a straw when you're trying to drink through it. The more you press, the less of your drink can squeeze up through the straw. In the same way, less air can squeeze through tight airways into your lungs. So, what causes asthma? People with asthma have different triggers. Some people are sensitive to pet hair or dander. Others find that dust, pollen, smoke, or chemicals make them wheeze. You may have trouble breathing when you're under stress or working out at the gym. Often people with asthma have allergies that trigger their attacks. Others have a parent or other relative who has allergies. You may ask, how can you know for sure that you have asthma? During an asthma attack, you'll have trouble breathing. You may cough or wheeze as you try to draw air into your lungs. If you're having a severe attack, your lips and face may turn blue and you'll have a hard time getting any air. That's when it's time to call for emergency help. Your doctor will listen to your lungs with a stethoscope, and may do other tests to check your blood and lung function. To find out what's triggering your asthma, you may need to be tested for allergies to mold, pollen, pet dander, or other substances. To measure the strength of air flowing out of your lungs, you'll blow into a device called a peak flow meter. You can also use a peak flow meter to make sure you're keeping your asthma under control. Different medicines are used to prevent and treat asthma. Control drugs help you avoid asthma attacks, but you need to take them every day for them to work. You breathe in control drugs like Flovent, Singulair, and Pulmicort through an inhaler. If you're having an asthma attack, you can take a quick-relief drug to control your wheezing. Examples of quick-relief drugs include short-acting inhaled drugs and steroid medicines that you take by mouth. When you have asthma, you need to be prepared. Know your asthma triggers and try to avoid them. Carry an inhaler with you in case you have an asthma attack. If you ever have an attack that's so severe you can't breathe, call 911 or get emergency medical help.

  • Exercise-induced asthma

    Exercise-induced asthma - illustration

    Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. People who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.

    Exercise-induced asthma

    illustration

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Review Date: 1/13/2020

Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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