Some people only experience asthma during and/or after exercise and are virtually unaware of the condition otherwise. One of the most obvious signs of EIA is that you get symptoms within a few minutes of stopping exercise. These symptoms usually worsen and the problem can last for up to half an hour.

Because you hyperventilate through your mouth when exercising, the air that reaches the bronchial tubes inside your lungs is not warmed and humidified like the air that enters through your nose. The larger amounts of cooler and drier air you take in while exercising, triggers asthma symptoms.

If you never do any exercise and suddenly have to run for a bus then you could have a serious problem. Exercising at a gentle level at first and gradually increasing it is the sensible way to go.

Helping Reduce EIA
First, you should not exercise if asthma symptoms are already present.

People whose asthma is triggered by inhaled allergens such as pollens may find exercise more difficult in certain places and at certain times of the year. Try another sport or venue if this be the case.

In cold temperatures, wear a mask or a scarf to warm and moisten the air reaching your airways.

Warming up before and warming down after exercising can help ward off the symptoms of asthma.

It is often suggested that asthmatics should take two puffs of reliever medication 5 to 15 minutes before exercising to protect against asthma. However, if you use relievers in this way, this protective effect against EIA may diminish after regular use.¹ Further studies into the use of Salmeterol (a long acting bronchodilator), showed significant protection against EIA at 6 and 12 hours after the first dose, however it was not effective after 4 weeks of continuous dosing.²

Walking is easy to do, costs little and can be done almost anywhere. If cold air is usually a problem wrap your face in a scarf and don't forget to take your inhaler with you!

EIA can also be greatly reduced you pace yourself so that you can nose-breathe while exercising. At first this will mean walking or jogging slowly, but over a short period of time fitness and speed will improve. It is virtually impossible to breathe through the nose when swimming but because breathing is not fast or continuous this does not seem to be a problem. Unless the asthmatic is allergic to chlorine or finds cold water makes him breathless then swimming is another good thing to do regularly for fitness. Again, don't forget to keep an inhaler in your bag close to the pool.

Sports or forms of exercise which require more effort need to be approached cautiously until you reach the level of physical fitness required.

Sports and activities more likely to trigger Asthma
Running Cycling Aerobics	Soccer Cross-country skiing
Sports and activities less likely to trigger Asthma
Swimming Walking Volleyball Baseball Weight Lifting	Sprints Golf Tennis Football

Warming Up & Down
A good warm up may help to reduce EIA. Try walking, jogging or skipping, stretching exercises, and running rapidly on the spot for 30 seconds, followed by a sixty second rest. Build up the level of intensity gradually.

When you have finished exercising take the time to warm-down. Do not stop suddenly as this can aggravate the airways by allowing temperature and humidity to change abruptly. Take a 10 minute warm down, including walking and stretching.

Medication and Sport
Asthmatics should compete at a sporting level that they can manage. It is pointless to exercise at such a level that it gives you asthma. It is vital to carry your inhaled reliever with you. Keep it in your pocket or bag and use it when you begin to get asthma symptoms.

People exercising in organised sports will need to find out about the rules of taking prescribed drugs by contacting their national sporting organisation or the national sports drug agency. For example, inhaled steroids such as Flixotide, Becotide and Pulmicort are permitted in competitions but Prednisone is not. The higher the competition, the more important this will be.

The International Olympic Committee Medical Commission has banned all oral and injectable beta2 agonists.

Of the beta2 agonists only salbutamol, salmeterol and terbutaline are permitted and only by inhalation. Any physician wishing to administer beta2 agonists by inhalation must give written notification to the relevant medical authority. The choice of medications to treat asthma and other common respiratory disorders pose problems because some of the more commonly prescribed substances are powerful stimulants. Furthermore because these drugs have many different product names, the status of a drug may be confusing. The most prudent approach is to never take or prescribe a product for colds, sore throats, and flu without first checking with a physician or pharmacist who has special expertise in this area.
IOC Medical Commission, September 1995, updated January 1996.

At high levels you must be registered as an asthmatic and specify your medications. If you are drug tested and show a positive test to salbutamol (Ventolin) you can be disqualified unless you are already registered.

As you don't want this to happen - advise your sporting association even if you only take one puff of reliever every six months.

The fact that there are many sports people playing at very high international levels should remind you that asthma does not have to stop you from participating.

1. Gibson GJ, Greenacre JK, Konig P, et al: Use of exercise challenge to investigate possible tolerance to beta-adrenoceptor stimulation in asthma. Br J Dis Chest 72:199-206, 1978