Exercise-Induced Asthma

About two years ago, I was just past the mile mark in a 10k when I felt a tightness in my windpipe. I had some difficulty getting air in and out. I tried couching to get rid of the feeling, but it persisted. I continued running, coughing intermittently, and after a few minutes the tightness went away. I finished the race with no further difficulty.

From then on, this sensation of my throat closing down became a regular occurrence in my races. It always came on early and always cleared before the finish. Eventually, I realized that I had exercise-induced asthma, or EIA.

My experience in developing exercise-induced asthma is increasingly common. One of the surprises in sports medicine has been the prevalence of this condition in athletes. Surveys indicate that 10 percent of athletes have EIA. Given its atypical manifestations and the lack of suspicion on the part of physicians, this may represent a low estimate. It is likely, for instance, that the 20 percent of our population with hay fever contains prime candidates for exercised induced asthma.

Undoubtedly there are many runners and athletes who never suspect that their cough or “hyperventilation” or “stitch” is due to EIA. In some runners the only symptom may be "inability to improve." Even should they consider the possibility, by the time they are seen in the physician’s office, their physical findings and pulmonary function tests will be normal.

Asthma is due to a transient bronchoconstriction. Between attacks there will be no evidence of the condition. Therefore, establishing the diagnosis requires a procedure that will precipitate the bronchoconstriction. Six minutes at race pace should, and usually does, result in diagnostic changes in pulmonary tests. This six minutes can be done on a treadmill or by simple running outside the doctor’s office.

Progress in understanding EIA has been rapid. Cold, dry air is especially likely to cause attacks. Sufferers must take steps in cold weather to heat and, if possible, to moisten the air. A ski mask without a mouth opening will achieve this purpose. It is also necessary to keep the face warm. Cold air striking the face and not inhaled can also cause symptoms.

I wear the mask as soon as the weather turns cold. I look on cold as relative. It need not be freezing to cause bronchoconstriction. I also take a prolonged warm-up before my races with a few flat-out sprints. I hope thereby to desensitize myself to asthma. I have the idea that a brisk 440 would do the trick, but I hate to do that before a race.

But mainly I rely on my medication, a beta-agonist inhalant (please check with your doctor). I position the inhaler several inches from my open mouth, exhale normally, then use the inhalant with a deep inhalation I hold for 10 seconds. I wait a few minutes and take a second puff. I do this two hours prior to a race, repeat it one hour later and then a final time 15 minutes before I go to the line.

If I follow this routine, I have no asthma during the race. The times I've failed to adhere to this schedule, the difficulty in breathing has recurred. I know I am lucky to find my simple measures that effective. I have met other runners with asthma who have to do much more. At times a persistent sinusitis makes the asthma extremely difficult to treat. Food, air pollution and inhalant allergens can be important factors. The help of an allergist with considerable experience treating EIA in athletes is almost always necessary. This is especially true if cortisone is required to restore normal running.

Be assured that in almost 100 percent of cases, exercised-induced asthma can be controlled. There should be no need to stop your sport. You should not even have to settle for diminished performance. The asthmatics who won medals in the last Olympics are testimony to that.

The most difficult step in treating this condition is making the diagnosis. After that, the athlete should be home free. Effective therapy is available. All you need is a physician who knows how to use it. (1986)