Exercise – induced asthma is common but controllable

Swimmer Nancy Hogshead, an Olympic gold medalist, retired from competition in 1984. But she still employs one winning strategy every time she works out: Before getting into the pool, she breathes from an inhaler containing asthma medication.

Rather than let the disease consign her to the bench, Hogshead has learned to control it. And she’s not alone. Jackie Joyner-Kersee won gold in spite of a history of asthma. In fact, according to William Storms, M.D., a physician who specializes in treating athletes with asthma, an estimated 10 percent of all Olympic athletes suffer from it.

Asthma occurs when the muscles surrounding the airways in the lungs constrictor undergo a spasm. The tightening, called bronchoconstriction, can be set off by a number of things, including allergies, upper-respiratory-tract infections and cold air. Whatever the cause, having asthma feels like breathing through a narrow straw. Your chest hurts, and you may wheeze or have difficulty controlling a cough.

Of the more than 10 million Americans with asthma, 80 percent find that exercise–and sometimes only exercise triggers an asthma attack. This condition, called exercise-induced asthma (EIA), crops up about 10 minutes into a workout and usually peaks after the workout stops. It’s symptoms, which generally resolve themselves in 30 to 60 minutes, are rarely serious or deadly. But EIA does affect the quality of life and, if not reckoned with properly, sidelines athletes.

Ironically, although exercise brings on EIA, improved physical fitness brings improved asthma control. An explanation for the contradiction lies in EIA’s source. Experts believe that one reason EIA occurs is that the airways cool and dry out as the lungs work hard during exercise. But because improved fitness means easier breathing during exercise, the risk of triggering an attack is reduced through better conditioning. Aerobically fit asthmatics have fewer asthma attacks and less need for medication. And according to Henry Gong, M.D., chief of environmental health services at Rancho Los Amigos Medical Center in Downey, California, aerobic fitness also increases the amount of exercise it takes to provoke an EIA attack in the first place.

Asthmatics don’t always experience attacks when they exercise, but many remain afraid to work out. When people with mild to moderate asthma were surveyed at the Asthma Centre of the Toronto Hospital in Ontario, Canada, have admitted that shortness of breath kept them from exercising–yet 80 percent had never received any advice about exercise. Their asthma was a major roadblock, but it needn’t have been if they’d been taught how to exercise safely.

Even worse, some physicians fail to recognize asthma symptoms. One unfortunate myth that hinders diagnosis is that asthmatics always wheeze. For instance, in one study teenagers with chest pains related to exercise were referred to a cardiologist for examination. Three-quarters of them were found to have EIA, and most never wheezed.

Hogshead, who was surrounded by team physicians, was never diagnosed as having EIA until after she’d won three Olympic gold medals. She had symptoms for nine years–and lived with a physician father. “I probably had a hundred times more opportunities to be diagnosed than the average person, and I wasn’t,” says Hogshead, whose chief symptom was coughing, not wheezing. A former president of the Women’s Sports Foundation, Hogshead lectures about asthma to help others lead active lives and has written a book called Asthma and Exercise (Henry Holt, 1991).

Preventive Measures

Most asthmatics can safely participate in almost any kind of physical activity, but taking preventive measures to avoid symptoms is a good idea. Choosing a sport that minimizes the triggers of EIA is one solution. Swimming, for instance, is a smart pick because it provides a warm, humid environment. Cold, dry air, on the other hand, promotes cooling and water loss in the airways, setting off EIA. Running is a particular offender while walking and bicycling fall somewhere in between. But that doesn’t mean you can’t participate in any of those activities. EIA can be minimized with some practical safeguards:

* Breathe slowly through your nose to warm the air before it hits your lungs. Or wear a mask or scarf around your nose and mouth to warm and moisten the air.

* Include longer warm-up and cool-down sessions in your workouts to prevent sharp temperature changes in the lungs.

* Exercise indoors to reduce exposure to ozone and sulfur dioxide pollution. If nature beckons, exercise early in the morning in low-traffic residential areas.

* Use antihistamines if outdoor allergens like pollen trigger your asthma attacks.

* Avoid eating foods that aggravate EIA less than two hours before exercise. Shrimp, celery, peanuts, egg whites, almonds and bananas are the chief culprits.

* Stay hydrated. Drink small amounts throughout an exercise period.

* Try using a peak-flow meter–an inexpensive device, available at most pharmacies, that measures lung function and can predict an asthma attack.

* Talk to your doctor about the possibility of medication (see Well-being, page 80).

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