Could you have exercise-induced asthma?

You expect to huff and puff a bit when you exercise. Maybe you’re new to working out, or you’re upping the intensity of your usual routine. But if you have symptoms such as wheezing and coughing that never seem to improve, you may have exercise-induced asthma. And many people who have it don’t know it.

“People sometimes think they’re out of shape when they actually have exercise-induced asthma because the symptoms are so similar,” says Kelly Simpson, MD. Dr. Simpson is an allergy and asthma specialist at Austin Regional Clinic in Austin, Texas.

Exercise-induced asthma happens when the airways in your lungs temporarily narrow during physical activity. It may make you want to avoid exercising. In rare cases, exercise-induced asthma can be severe and life-threatening.

But the condition is treatable. Here’s what you need to know.

Symptoms of exercise-induced asthma

An exercise-induced asthma attack can start anywhere from 5 to 20 minutes into a workout. It typically goes away in about 30 minutes, according to the Cleveland Clinic. Symptoms include:

• Shortness of breath
• Wheezing
• Coughing
• Chest tightness
• Fatigue during exercise

Attacks usually occur when you’re doing high-intensity exercise or sports that require constant effort (like running, cycling or soccer), says Chiraag Patel, MD. Dr. Patel is an allergy specialist at Granite Bay Allergy, Asthma & Immunology in Roseville, California.

They’re less likely to happen during activities that require short bursts of energy, such as baseball or volleyball. But if you have bad exercise-induced asthma, even moderate activity such as walking could bring on symptoms, says Dr. Patel.

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Other triggers of an attack

Working out in certain conditions can also trigger exercise-induced asthma. These include:

• Cold, dry air
• Polluted air
• High levels of pollen in the air
• Irritating substances in the air, such as smoke or chemicals
• When you’re getting over a cold or other respiratory illness

Less severe cases can be trickier to spot, but there is a clue. “If the issue has to do with fitness level, the symptoms should get better quickly after you stop exercising,” Dr. Simpson says. “If you’re still coughing or struggling to catch your breath [after a short time], however, then it could be exercise-induced asthma.”

Who gets exercise-induced asthma?

Most people with the condition already have asthma, which causes inflammation and narrowing of the airways. But up to 20% do not.

It isn’t clear why it occurs among this other 20%. But research shows that certain people are at an increased risk of having exercise-induced asthma. These include:

• Women
• People who have a personal or family history of asthma or allergies

How to get relief

If you think you have exercise-induced asthma, talk to your doctor. They may refer you to an allergist or immunologist. You’ll likely undergo a test called spirometry that measures how well your lungs work when you’re resting. You may also take an exercise challenge test, where you run on a treadmill or climb stairs to increase your breathing rate. The doctor will perform a spirometry test before and after the activity to check for exercise-induced asthma.

The most common treatment is a short-acting inhaler that you take before exercise. This prescription medication keeps your airways open and helps reduce symptoms in most people, Dr. Simpson says. Options include:

• Albuterol (ProAir HFA^®, Proventil HFA^®, Ventolin HFA^®)
• Levalbuterol (Xopenex HFA^®)

Your doctor can let you know how much time you need between using the inhaler and exercising.

If a short-acting inhaler doesn’t work well for you, your doctor may recommend long-term control medications. These are usually taken daily. They include:

Inhaled corticosteroids, which ease inflammation in your airways. Some examples:

• Fluticasone (Flovent Diskus^®, Flovent HFA^®)
• Budesonide (Pulmicort Flexhaler^®)

Combination inhalers that include corticosteroids and a type of medication called a long-acting agonist. These medications relax your airways. Combination inhalers include:

• Fluticasone and salmeterol (Advair Diskus^®)
• Budesonide and formoterol (Symbicort)

Leukotriene modifiers (an oral medication that blocks inflammation), including:

• Montelukast (Singulair^®)
• Zafirlukast (Accolate^®)
• Zileuton (Zyflo^®, Zyflo CR^®)

The takeaway: There are lots of treatment options for exercise-induced asthma, and it doesn’t need to — and shouldn’t — keep you from doing the activities you enjoy.

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Additional sources
Duration of an attack: Cleveland Clinic (2021). “Exercise-Induced Asthma”
Statistic: StatPearls (2021). “Exercise Induced Asthma”