Good Asthma Control Includes Being Able to Exercise Without Limitations

James Thompson, MD Health Pro
  •  A parent of one of my 10 year old asthma patients found that the Phys ed teacher frequently assigned her son to the goalie position during soccer games because of his exercise related breathing problems. The child was embarrassed and discouraged by his being singled out because of his soccer field struggles. The problem here is mom was not aware of the exercise related breathing problem and learned of this after several months. The child had exercise induced asthma and should have been treated for it.

    Did you know that about 80 percent of people who have asthma have exercise induced asthma (EIA)? In fact, reports show that 7-10 percent of Americans overall have EIA. In situations of EIA your asthma may seem to be under good control but yet may be limiting your capacity in sports activities or exercise. Sometimes people mistakenly think they have shortness of breath, chest tightness, and wheezing because they are out of shape. Too often it is assumed that the exercise related asthma symptoms are a normal and accepted aspect of asthma. But these impressions would be wrong!

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    The goals of asthma therapy, according to the National Institute of Health (NIH) expert asthma a panel, are:           

    • Preventing long-term (chronic) symptoms that interfere with daily living, such as coughing or shortness of breath during the night or after exercise.
    • Maintaining lung function near the personal best measurement.
    • Allowing the person to participate in all activities of daily living, including work, school, and exercise. Treatment to decrease nighttime symptoms and achieve uninterrupted sleep also is important.
    • Preventing repeated asthma attacks.
    • Providing the best medicine treatment with the fewest possible side effects.
    • Meeting you or your family's expectations for you or your child’s asthma care. Effective treatment for asthma involves a partnership between the person, his or her family, and the doctor.


    Exercise induced asthma should be directly addressed in every patient with the diagnosis of asthma. First, it must be recognized through discussion with your doctor. Exercise or sports activities that are associated with unusual or prolonged shortness of breath, wheezing, chest tightness or cough during or soon after the activity may represent EIA. Your doctor will ask for more details about the symptoms and circumstances in order to determine whether the problem is related to exercise alone, or other triggers. The most common reason for EIA is poor control of day to day asthma.


    When should you suspect Exercise Induced Asthma?


    Vigorous physical activity may be associated with asthma symptoms (shortness of breath, chest tightness, wheezing or cough) during exercise or within 5-20 minutes after the activity. Often there is a need or desire for reliever inhaler (albuterol). Parents should be vigilant about their child’s tolerance of PE (physical education) activities in school.


    How is Exercise Induced Asthma diagnosed?


    Before making the diagnosis of EIA your doctor will want to certify that your asthma is well controlled when not exercising. This means:


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     - There should be no limitations with daily routine.


     - Asthma symptoms should be less than three days/week (during normal routine).


      - Night time asthma symptoms should be less than three days/month.

      - Lung function test or peak flow rate should be normal (or at personal best).


      - Asthma Control Test score is greater than 19 (if on controller medication).


     - You have not sustained an asthma attack, emergency or urgent doctor visit, or had oral or injected steroid any more than once in the last 12 months.

    If all the above parameters for good asthma control are met, EIA is the most likely reason for asthma symptoms associated with exercise. A lung function test is usually ordered in order to certify normal function when not exercising. Ideally, a pre-exercise pulmonary function test or peak flow rate would be compared with a post-exercise breathing test (a breathing test done 5 and 10 minutes after exercise). Sometimes we provide a peak flow meter for the patient or parent to conduct this pre/post exercise analysis.

    Is there a treatment for Exercise Induced Asthma?

    There certainly is! Your doctor should provide you with a course of action. If non-exercise lung function is normal, and no other triggers are suspected (for example indoor or outdoor allergens or pollution causing asthma when exercising) the first line of treatment is usually to take 2 puffs of your reliever inhaler 15 minutes before exercise or sports. If this doesn’t work, there are other steps that can be considered by your asthma care provider. Before considering further steps your inhaler technique should be reviewed by your doctor. Warm-ups before exercising may also help.


     Remember to consult your doctor before making any adjustments of asthma treatment.


    Do you have asthma symptoms associated with exercise or sports activities?


    What has worked for you?

Published On: May 31, 2011