Exercise: Is it a Breeze or a Wheeze?

Have you ever been out on a great walk or run, when you were interrupted by wheezing? Or perhaps after your workout you started wheezing and/or coughing. This is frustrating, and it can be serious! If this has happened to you, you’re not alone!

Over 14 million people in the United States are affected by a chronic lung disease asthma. Contrary to popular belief, asthma is not just for kids. Adults in their 30s and 40s, and even seniors can (and do) develop asthma. Asthma is characterized by three airway problems: obstruction, inflammation, and hyperresponsiveness. Airway obstruction is responsible for the wheezing and coughing associated with asthma. It is believed that airway obstruction is initiated by inflammatory events in the airway. Airway inflamation is brought on by the release of histamine from the mast cells, and causes the glands within the inner walls of the lungs to produce excess mucus or phlegm. This process results in an increase in airway smooth muscle responsiveness, and airflow obstructions. Airway hyperresponsiveness is a reaction to allergens, smoke, smog, perfume, infections, cold air, medications, stress, sulfites, and exotic exercise. These are called “triggers” of asthmatic symptoms.

The parts of the lung most directly affected by asthma are the bronchi and bronchioles. The bronchi, like a tree, continue to branch into smaller tubes, deep into the lung. The smallest of these tubes are the bronchioles, which open into sacs called alveoli. These sacs are separated from the blood vessels of the lung by a thin membrane. Across this membrane, inhaled oxygen is absorbed into the bloodstream and carbon dioxide is passed into the alveoli to be exhaled. During an asthma attack, the muscles surrounding these airways contract (bronchospasm), causing a narrowing of the tubes. This results in restricted airflow and an interruption in the gas exchange process. The production of mucus follows, resulting in the wheezing/coughing response.

For decades, asthma was associated only with allergies. However, studies over the past generation have revealed much about asthma being triggered by exercise. Exercise Induced Asthma (EIA) or Exercise Induced Bronchospasm (EIB) is the onset of asthmatic symptoms as a result of exercise. These symptoms include wheezing, shortness of breath, tight chest, and coughing—either during or within a few minutes after exercise. These symptoms can arise as a result of various intensity levels of activity. When I was first diagnosed with EIA, it was any level of activity that triggered the response. In well conditioned athletes, the symptoms usually occur when they “push their limits.” Some old beliefs among athletes, and coaches, were that these symptoms were a sign of “small lungs” or being “out of shape.” If you’ve been told that don’t believe it!!

On September 28, 1986 I completed running my fourth marathon. Having the training base, and being somewhat of a masochist, I decided to prepare for an upcoming 50K. Unfortunately, I came down with a respiratory infection and couldn’t compete, or maintain my training schedule. I suffered on and off with the infection until January 1987. When I resumed my training I wasn’t able to run a 9:00 mile without severe wheezing, followed by about 20 minutes of coughing. In just a few months, I went from a runner of a 5:36 mile, a 40:43 10K, marathons, triathlons, and X/C Ski racing, to ZIP!!

Now, after several years of treatment and specific training techniques, I am usually only bothered with EIA when I approach my ANAEROBIC THRESHOLD during exercise. In other words, if I am doing speed/interval training or racing. AEROBIC levels of exercise don’t trigger a response. I’ve never had an episode of EIA while swimming in an indoor pool, at any pace. It is believed that the warm humidified air at the water’s surface keeps the bronchial tubes from drying and cooling. With the proper use of medication, self-management techniques, and intelligent training, I have achieved many PR’s in the sport of Race Walking: 7:52 mile; 15:43 2 mile; 26:42 5K; 56:24 10K.

The most common method of administering EIA medication is the inhalation aerosol (“puffer”). I also have used Rotacaps®—a capsule containing medication in powdered form, that is also inhaled. After several years of working with my pulmonary physician and participating in EIA studies in Eugene, OR, I have been able to keep my EIA under control and get back into recreational and competitive sports. The following medications are currently prescribed for me:
• Preventive Medication (pre-treatment): I use Intal® (cromolyn sodium) 30 minutes before every hard workout or race.
• Recovery Medication (post-treatment): With the onset of an asthma attack, I inhale two puffs of Ventolin® (albuterol, USP).
• Maintenance Medication: On a daily basis, I inhale two puffs of Serevent® (salmeterol xinafoate), A.M. and P.M.. I also inhale two puffs of Aerobid® (flunisolide) four times daily.

PLEASE NOTE: I’m not prescribing medication—I’m merely explaining what my EIA management routine is. If you are or suspect that you may be an asthmatic, seek medical advice from a pulmonary physician, preferably one specializing in athletic respiratory disorders.

If you have experienced wheezing and/or coughing in conjunction with exercise, see your health care provider. Asthma symptoms are not specific, and your symptoms may be some other medical condition. You can be tested for EIA. Your physician will want a history of your symptoms and an analysis of your lung function using a spirometer—a device that measures air flow. Once diagnosed with EIA, your physician can “fine tune” your medication with additional stress testing, utilizing cycling or treadmills.

Asthma is a chronic disease in which there is no cure, and requires continued therapy. Asthmatics must maintain control of their condition with medication and self-management techniques. The rising number of asthma deaths among children and young adults is alarming—the rate more than doubled between 1980 and 1993. There was recently an EIA related death at one of our local high schools. The athlete suffered an EIA attack during a track workout. My suspicion is that the athlete had not managed the prescribed medications properly. Be smart—be safe! Here is an EIA awareness check list:
•    Don’t use over-the-counter asthma medications.
•    Be aware of your triggers and avoid them.
•    Take your medication, exactly as prescribed, even if you are not experiencing asthma symptoms.
•    If an attack occurs during a workout, stop and medicate!
•    Restrict exercise when you have a viral infection or pollen and air pollution levels are high.
•    Adequately warm-up before and warm-down after exercise.
•    See your pulmonary physician regularly, at least annually.


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