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Asthma, as we all know, is a long-term condition affecting the airways in the lungs. In this article, we shall take a closer look at a particular type of asthma called Sports-Induced Asthma.1 The lungs’ airways are tubes that carry air in and out. The central airways are called Bronchi, and these bronchi branch off into smaller passageways called Bronchioles.
When these airways inflame and become narrow, they lead to sports-induced asthma. Asthma is often diagnosed in childhood but can also affect people of all ages.
1. Sports-Induced Asthma
Sports-induced asthma is otherwise called Exercise-Induced Asthma2(EIA). It is also called Exercise-Induced Bronchoconstriction3(EIB).
Exercise can act as a trigger factor for those who are already asthmatic, but it can also be the sole cause that induces asthma in a patient(during or after exercise). In a nutshell, sports or exercise can act as an inducing factor or a triggering factor for asthma.
People with allergies and asthma are more likely to suffer from this condition.
Sports-induced asthma occurs in about 50% to 90% of people already suffering from asthma and in about 20% of non-asthmatic patients.
In this condition, any strenuous physical or aerobic activity causes the airways to swell and constrict(become narrow), making breathing difficult.
Not only bronchoconstriction(narrowing of airways) but also reversible contractions of the bronchial smooth muscles produce symptoms of Asthma4. This is known as exercise-induced bronchospasm.
2. What Are Bronchial Or Airway Smooth Muscles?
These are the muscles surrounding the airways, which automatically open(dilate) and close(constrict). This mechanism of the muscles controls the passage of air into and out of the lungs.
When a person is subjected to a triggering factor like exercise, these smooth muscles contract, which exerts pressure on the airways, causing airway narrowing. Though this narrowing is reversible, it produces asthmatic symptoms5.
3. How And Why Does Exercise Trigger Asthma?
We breathe in more air when we are engaged in strenuous activity, such as exercise or sports, than at rest. This is to provide enough oxygen to the muscles and other parts of the body while not feeling out of breath.
The air we breathe in needs to be warm and humid as it is easier to breathe this type of air. Inhaling through the nose is the best way to humidify the air.
However, during exercise, as the body requires more oxygen, we breathe not only through our nose but also through our mouth. The mouth does not have the ability to humidify the air.
Also, as we all know, nasal hair acts as a filter and prevents dust, allergens, and other irritants from entering the airways. The mouth does not have any such protective mechanism.
As a result, a large amount of cool air and irritants tend to enter the body and irritate the airways, causing them to constrict and inflame, resulting in asthma symptoms.
4. Sports-Induced Asthma Symptoms
Symptoms develop when airways narrow due to physical activity. The typical exercise-induced symptoms are:
- Cough – the most typical symptom and maybe the only symptom
- Increased mucus production leading to cough
- Wheezing – a high-pitched whistling sound heard while asthmatic patients breathe.
- Dyspnea or Shortness of breath
- Chest tightness
- Chest pain due to frequent coughing but is seen rarely
- Severe fatigue or tiredness
These symptoms lead to poor athletic performance in an athlete and avoidance of activity in children.
Very rarely, there may be severe shortness of breath and respiratory failure, which might be fatal.
These symptoms may develop immediately or within 5-20 minutes after stopping exercise. Symptoms may also persist after the activity is stopped and at rest. An asthma episode usually resolves within 20-30 minutes. Some individuals experience a second wave of symptoms, 4-12 hours after exercising. These are called late-phase symptoms.
Not everyone experiences exercise-induced asthma symptoms. Mild symptoms of exercise-induced asthma may resemble symptoms of being physically unfit. Thus, many times, EIA remains undiagnosed.
Inability to perform exercises or fear of exacerbations leads to poor quality of life.
5. Factors Worsening Sports-Induced Asthma
The following are the risk factors that trigger EIA:
- Cold, dry air
- High irritant and pollen counts
- Extremes of temperature, especially a cold weather
- Increased air pollution levels
- Smoking-active or passive
- Respiratory infections
- Chemicals like chlorine in swimming pools
- Participation in high-risk sports which include longer duration of exercises
- The female gender may also be more subjected to EIA
6. What Causes Sports-Induced Asthma?
- People who are already suffering from Asthma.
- Complex interactions between genetic and environmental factors mean that a family history of asthma and several environmental factors play an essential role in the etiology of EIA.
- A cold and dry environment where pollution levels are high.
7. Which Sports Cause Sports-Induced Asthma?
Sports that take place in cold, dry air like Ice hockey, Skiing, Ice skating, Snowboarding, and Cross-country skiing.
Sports require constant activity like long-distance running, soccer, and basketball.
Many elite athletes are affected by this illness but continue to perform in their sports despite it and excel in it. These Olympic athletes are ignorant of this illness and misinterpret the signs and symptoms of over-exertion.
8. Diagnosis of Sports-Induced Asthma
8.1. Diagnosing Sports-Induced Asthma
To diagnose sports-induced asthma, a thorough history and physical exam are required. The patient’s medical history and their family’s medical history are taken into account. Previous asthma attacks or exercise-induced asthma are also considered as the diagnosis is primarily clinical.
Measurement of lung function is done with a spirometry test. A spirometer is a small handheld medical apparatus that measures how well the lungs function. It helps to access the breath volume and rate, and amount of air that is inspired and expired.
8.2. Conducting of Tests
The doctor conducts this test during and after the activity. After the activity, medications are given to open and dilate the lungs and airways, and measurements are taken to see if the medication has improved the airflow.
8.3. Exercise Challenge Tests
The doctor may ask the patient to perform intense exercises to produce symptoms of EIA like walking on a treadmill. This enables the doctor to assess the symptoms. Spirometry tests before and after the exercise challenge may provide evidence of sports-induced asthma.
9. How To Treat Sports-Induced Asthma?
If treatment is early and appropriate, Exercise-induced asthma will not restrict one’s ability to engage in strenuous physical activity.
9.1. Medications and Prevention Prior to Exercises
- Warm up Before Exercise
Warming up before exercising plays an important role and should be practiced before indulging in an exercise or a sport.
- Wearing a Scarf or a Mask
Wearing a mask during the activity, especially in areas where the air quality is poor, and the atmosphere is inappropriate to prevent symptoms.
Inhaled Beta 2 Agonists
- Short-Acting Beta-Agonists(SABA)-
SABA like Albuterol and Levalbuterol are called rescue inhalers and are a type of bronchodilator. They act by dilating the airways and improving breathing efficiency. These medications should be taken about 15 minutes prior to exercise. They control symptoms for about 2-3 hours.
- Long-Acting Beta-Agonists(LABA)-
LABA like Salmeterol- these medications act by opening the airways in the lungs by relaxing the smooth muscles around the airways. These are used as a pretreatment to exercise and should be taken 30 minutes -1 hour before exercise. These are longer-acting drugs.
- Leukotriene Receptor Antagonists or Leukotriene Modifiers
These medications block the inflammatory activity of the airways, thus, providing relief. These drugs are montelukast and zafirlukast. Side effects like mood and behavioral changes occur commonly with these drugs.
- Mast Cell Stabilizers
Mast cell Stabilizers like Nedocromil and Cromolyn sodium are pretreatment medications as they prevent EIB but do not prevent symptoms once they start. This medicine can be taken about 15 minutes before exercising. It can be inhaled through a nebulizer.
- Ipratropium
This is another medication falling in the class of a bronchodilator, making breathing easier. These medications help to prevent airway narrowing that is triggered by exercise.
9.2. Long-term Control Medications
- Inhaled Corticosteroids
These medicines suppress the inflammatory process and help in relieving symptoms. These medications include fluticasone and beclomethasone.
- Combined Inhalers
They relax the airways, improve breathing and reduce asthma symptoms. These inhalers are a combination of corticosteroids and LABA like Fluticasone+Salmeterol, respectively.
9.3. Breathing Exercises
Breathing exercises increase the efficacy of breathing and improve lung function.
- Diaphragmatic Breathing
It is a type of breathing in which we inhale through the nose and exhale through the mouth. It is an effective way of breathing in which only the primary breathing muscles are used.
- Nasal breathing
Breathing through the nose helps in safe breathing. Nasal breathing is more effective than breathing through the mouth.
- Pursed-Lip Breathing
This is a type of breathing in which we breathe slowly and deliberately. This type of breathing gives us more control over our breathing.
Not only medications but other preventive measures should be followed.
9.4. The Preventative Measures
- using an inhaler before exercise and sports
- try to know your trigger factors and avoid them
- warm-up before beginning exercise and cool down later
- making use of a scarf and mask which helps to reduce exposure to irritants
- avoid sports in the dry and cold air as it can trigger exercise-induced asthma
- avoid sports requiring continuous activity
- exercising in humid and warm air
- start exercising indoors to remain physically fit and when the atmosphere is unfavorable
- quit smoking
- breathing through nose
- avoid environments with high pollutants and irritants as this can prevent asthma symptoms
- take asthma medications before exercise
- consult the healthcare provider before beginning an exercise program
- if a parent notices any such symptoms in their child, contact the child’s doctor
- if symptoms start, exercise should be avoided until they stop
10. Conclusion
Sports-induced asthma, also known as exercise-induced bronchoconstriction (EIB) or exercise-induced asthma (EIA), is a condition where physical activity triggers the narrowing of the airways in the lungs, leading to symptoms similar to asthma. This condition is more common in individuals with pre-existing asthma but can also occur in people without a history of asthma.
During exercise, the body’s demand for oxygen increases, causing the breathing rate to go up. In individuals with sports-induced asthma, this increased breathing can lead to airway inflammation and constriction.
Diagnosis of sports-induced asthma typically involves a combination of medical history, physical examination, and lung function tests. These tests may include spirometry, which measures lung function before and after exercise, and bronchoprovocation tests, where a patient is exposed to a substance that may trigger airway constriction.
The bottom line is that even if you are suffering or are prone to suffer from exercise or sports-induced asthma, you can exercise safely. The only thing you need to take care of is to control your symptoms very well. Always follow your doctor’s instructions and see a doctor if you continue to experience symptoms or have new and worsening symptoms.
FAQs
1. What are the treatment options for sports-induced asthma?
A. Treatment options include short-acting bronchodilators (inhaled medications that relax the airways), long-acting bronchodilators, and anti-inflammatory medications. A doctor will determine the best treatment plan based on an individual’s symptoms and needs.
2. Can I still participate in sports if I have sports-induced asthma?
A. Yes, many individuals with sports-induced asthma can still participate in sports and physical activities. Proper management, including using prescribed medications and following a personalized plan, can help control symptoms and allow for active participation.
3. Can sports-induced asthma improve over time?
A. With proper management and treatment, many individuals experience improvements in their sports-induced asthma symptoms over time. Working closely with a healthcare provider can help develop an effective management plan.
Read more
- Becker, Jack M., et al. “Asthma deaths during sports: report of a 7-year experience.” Journal of allergy and clinical immunology 113.2 (2004): 264-267. ↩︎
- McFadden Jr, E. R., and Ileen A. Gilbert. “Exercise-induced asthma.” New England Journal of Medicine 330.19 (1994): 1362-1367. ↩︎
- Gotshall, Robert W. “Exercise-induced bronchoconstriction.” Drugs 62 (2002): 1725-1739. ↩︎
- Tillie‐Leblond, I., et al. “Relation between inflammation and symptoms in asthma.” Allergy 64.3 (2009): 354-367. ↩︎
- Eijkemans, Marianne, et al. “Asthmatic symptoms, physical activity, and overweight in young children: a cohort study.” Pediatrics 121.3 (2008): e666-e672. ↩︎
Last Updated on by ayeshayusuf
Very informative . Thank you