Exercise-Induced Asthma: Why Asthma Is Anything but Unathletic

Some of the highest-performing athletes in the world have asthma. Yes, you read that right. In fact, according to pulmonologist Tod Olin, MD, who frequently works with Team U.S.A. Olympians, asthma affects roughly one out of five elite athletes.

“The longer you compete, the more likely you are to get asthma,” said Dr. Olin. “You can think of it as an occupational risk to continuous high-volume cardiovascular exercise. And if we look at the number of medals won by athletes with asthma versus those without, it’s either equal or in favor of athletes with asthma.”

These facts certainly run counter to the stereotype. In film and television, characters with asthma are often depicted as weak and unathletic (Opens in a new window) (Opens in a new window). Many kids grow up believing an asthma diagnosis means getting sidelined, both in sports and in their social lives. The reality is that exercise and asthma are intertwined. If you find that you’re experiencing breathing difficulties during or after exercise, you don’t have to accept them. Exercise-induced asthma (EIA) — where asthma symptoms are brought upon by exercise — is extremely common, and the diagnosis and treatment of EIA can radically improve performance for everyone from athletes to people who want to stay fit.

EIA Symptoms Are Subtle

EIA symptoms are rarely obvious, according to Dr. Olin, who leads the Exercise & Performance Breathing Center at National Jewish Health. “It’s not a lights-and-sirens emergency,” Dr. Olin said. “It’s more that you’re having a subtle cough that’s slow to trigger, slow to resolve. It usually doesn’t happen right after you exercise. There’s a bit of a delay.”

There is a lot of variation with EIA symptoms. However, the most common are:

Coughing
Wheezing
Shortness of breath
Tightness in chest or slight pain
Poorer athletic performance
Fatigue

People sometimes associate asthma with dramatic symptoms like collapsing, but this is rarely the case. And, because these symptoms don’t seem to cause too much of a problem, many people choose to ignore them, even when they could benefit from treatment. “They don’t want to be labeled as having asthma,” explained Dr. Olin. “And because of that, they let their asthma limit their abilities.”

Confronting the Asthma Stigma

“When young people start getting asthma symptoms during exercise, sometimes their parents will tell them they just need to suck it up,” said Dr. Olin. “We even have terms like ‘runner’s cough,’ as if these symptoms are just normal and don’t need to be investigated or treated. And sometimes adults will say that they used to have EIA but that they ‘grew out of it.’ Really, they just stopped exercising.”

According to Dr. Olin, the biggest challenge for EIA isn’t treatment but awareness. A lot of people either don’t know or don’t want to know they have asthma. “They think if they have it, they’ll be held back,” he explained. “But the fact is, not knowing you have it is what holds you back the most, because you can’t be treated.”

An asthma diagnosis doesn’t place a limit on your active lifestyle. Dr. Olin has treated numerous athletes at the highest level for asthma, and some have medaled at the Olympic Games.

“Let’s Not Guess. Let’s Know.”

The value of proper EIA testing is:

1. Being able to get effective asthma treatment if you need it.

2. Being able to get the appropriate treatment if your condition is caused by something other than asthma, such as EILO (exercise-induced laryngeal obstruction).

People will sometimes spend thousands of dollars on asthma medications they don’t need because they haven’t had the proper testing. Meanwhile, the actual cause for their breathing difficulties is going untreated.

Asthma is a condition where the lungs have restricted air flow because the airways are squeezing down.

It's different than exercise-induced laryngeal obstruction (EILO), which is up here.

The throat is partially closing and it really restricts the air flow.

People with asthma describe the experience as some chest tightness, some cough, some frustration.

It's gradual.

It comes on slow.

It resolves itself slowly.

There's not exactly a distinct episode that changes on a second to second basis.

We treat asthma with medications.

We use inhalers.

Albuterol is the most commonly used agent on a minute to minute basis to deal with acute symptoms.

If you take your inhaler properly with a spacer, it'll tend to work if exercise is the trigger for asthma.

EILO looks really different.

You see somebody who's suffering, who's embarrassed, who's breathing noisy.

You feel compelled to do something.

You see them stopping after a minute and 45 seconds, just unable to keep up with everybody else.

We treat EILO with different breathing techniques.

We don't need medicines.

Our speech and language pathologists can teach different ways of breathing so that patients can keep their throat open when they're going as hard as they want.

If they've got these tools in their tool box, there's nothing that should hold them back.

“The risk of not being diagnosed and treated for EIA is a drop in performance,” said Dr. Olin. “At the same time, a lot of these people who have the symptoms of exercise-induced asthma just have regular asthma. And when it’s regular asthma, there could be higher risks of complications. So when it comes to EIA, let’s not guess. Let’s know.”

The Exercise and Performance Breathing Center team is well-equipped to make precise diagnoses of EIA and/or other causes of difficulty breathing with exercise. In fact, they are one of the few services in the country to offer eucapnic voluntary hyperventilation (EVH), a test specifically designed to detect EIA.

The EVH test simulates exercise conditions by introducing high airflow into patients’ lungs. “This is a great tool for people who can’t exercise for the test,” Dr. Olin explained. “Older people who can’t run, for instance. It’s also great for people who don’t show positive results with other tests.” You can be negative for EIA with a methacholine challenge, which is the gold standard for asthma testing, and positive with the EVH test.

“If you’re being treated and you’re not getting the result you want, come see us,” said Dr. Olin. “If you want to exercise in a certain way and you feel like you’re being held back by a breathing problem, that’s another reason to come see us.”

If you or someone you love is experiencing EIA symptoms, schedule an appointment with one of our Exercise & Performance Breathing specialists or learn more about our program.