What Is Exercise-Induced Asthma—And How Do You Know if You Have It?
Exercise-induced bronchoconstriction (EIB), can make it difficult to work out without triggering asthma symptoms—but it’s not impossible.
In many cases, it's totally normal—and actually a really positive sign—if you feel out of breath from exercise. That's because it can indicate you are putting in the hard work needed to maintain or improve your fitness.
But sometimes, getting super winded from a workout is not good news. Why? It could be a sign of exercise-induced asthma, a condition that is fairly common and very treatable, but also potentially dangerous if ignored.
So how can you know the difference between normal workout breathlessness and something that's a bit more worrisome? Here's what you need to know.
What is exercise-induced asthma?
Exercise-induced asthma, also known as exercise-induced bronchoconstriction or exercise-induced bronchospasm (EIB), is when exercise causes the muscles around your airways to narrow or spasm, making it difficult to breathe.
An estimated 5 to 20% of people have EIB. Not surprisingly, most folks with EIB also have chronic asthma that is triggered by other factors, like allergies, pollution, and bacterial or viral infections. About 20% of people who have EIB don't have chronic asthma and only experience asthma symptoms when they exercise, Purvi S. Parikh, MD, allergist and immunologist at NYU Langone Health, tells Health.
EIB may sound scary, but it is a very treatable condition. When properly managed, EIB likely won't impact your exercise routine too much. In fact, many Olympians and other high-level athletes have EIB, says Dr. Parikh.
What are the symptoms of exercise-induced asthma?
EIB symptoms can occur during or after your workout. At first glance, these symptoms may seem similar to how your body naturally responds to exercise. But there are some key differences, and it's important to be aware of them so that you can stop your sweat session if you suspect you're having an asthma attack. "It's dangerous to continue to exercise with your breathing compromised," warns Dr. Parikh.
In fact, exercise-induced asthma—and really, any type of asthma—can be deadly if uncontrolled. Dr. Parikh urges anyone with the following symptoms to stop working out and see their doctor ASAP about an EIB diagnosis. It's especially important to get evaluated since other serious conditions, like heart problems, can mimic EIB, she says.
EIB symptoms include:
- Difficulty breathing. This is more than being a little breathless from your workout. Instead, it can feel like you're breathing out of a straw, and the sensation may last after you stop exercising.
- Coughing. A small cough here and there is likely nothing to worry about, but hacking a ton during or after your workout can be a sign of EIB.
- Chest tightness and pain. More intense than typical exercise-induced chest tightness, this is a squeezing sensation in your chest, ribs, and possibly back that may continue after you stop your workout.
- Wheezing. Think: A whistling or rumbling noise as you breathe.
- Dizziness. This is a more serious sign of EIB that happens when your airway is so constricted that you aren't getting enough oxygen.
What are the causes or risk factors of exercise-induced asthma?
People with chronic asthma and those who suffer from allergies are most at risk for EIB. Beyond that, we don't have a super solid understanding of why some people have EIB while others don't, says Dr. Parikh. It may be partly genetic, she adds.
For people who do have EIB, various factors can trigger it. Any type of exercise can do this, but in general, cardio-centric activities and other intense workouts (think: running, HIIT routines, swimming, and heavy weight lifting ) are more likely to induce EIB than gentler forms of exercise, says Dr. Parikh.
Also, endurance sports that involve consistent effort (like soccer and long-distance running) seem to more commonly spark EIB than activities that involve bursts of hard work followed by lots of recovery (like baseball and football), Brian A. Smart, MD, allergist and immunologist in Glen Ellyn, Illinois, tells Health.
Weather may also play a role. For some people, exercising in cold weather—think: cross-country skiing, ice skating, or winter running— can prompt EIB. That's because cold, dry air can irritate the airways and cause the surrounding muscles to constrict, Miriam Anand, MD, allergist and immunologist in Tempe, Arizona and advisor to the Asthma and Allergy Foundation of America, tells Health. For other people, however, exercising in hot, humid weather can trigger EIB, says Dr. Parikh. Other triggers include pollution, allergies, and irritants like chlorine.
How is exercise-induced asthma diagnosed?
The EIB diagnosis process varies person to person, but in general, doctors will start by asking questions about your history to better determine whether you may have EIB. From there, they may perform a pulmonary functioning test, in which you blow into a tube hooked up to a computer that measures how well your lungs work and if there is inflammation in your airways. The results of that test can reveal whether you have asthma, says Dr. Parikh. Your doctor may also have you run on a treadmill and then measure your lung functioning afterward to see if it dropped significantly; if it did, that would indicate you have EIB, says Dr. Smart.
If your doctor suspects you have allergy-induced asthma in addition to EIB, they may run allergy tests. And if they believe another issue (say, a heart condition) might be triggering your EIB-like symptoms, they might order other evaluations, Dr. Parikh says.
What are the treatment options for exercise-induced asthma?
As mentioned, EIB is a very manageable condition and when treated correctly, it shouldn't impede your ability to work out.
"It's so important that people get regular exercise," says Dr. Smart, "and if they're making choices to exercise less because of a condition that is manageable, they should be seen" by a doctor.
The most common treatment for EIB involves inhaling a fast-acting asthma medicine, such as albuterol, before you exercise, says Dr. Anand. Albuterol works by relaxing the muscles around the airways, she explains. Most people take it about 15 minutes before a workout, and it typically works well enough to prevent EIB symptoms altogether, says Dr. Smart.
Other people, including those with chronic asthma, may need to take a daily anti-inflammatory medication, like a pill called Singulair, or an inhaled steroid, says Dr. Smart. Or, they may take a combination of long-acting asthma medicine plus a steroid. Your primary care doctor or a doctor who specializes in allergies and immunology can help you figure out which meds, if any, you should take for EIB.
Medication aside, you may be able to reduce the severity of EIB by spending more time gently warming-up and cooling down before and after exercise, says Dr. Smart. There's no magic number, but as a general rule of thumb, he suggests doubling the time of both your warm-up and cool-down. So if you normally do five minutes of dynamic stretching before and after you run, try 10.
Also, it may sound ironic, but people with EIB actually fare better if they regularly exercise. "Once they figure out their management plan, the severity will be better over time if they have better fitness," Dr. Smart explains. (That said, because of the dangers of EIB, you should avoid vigorous exercise until the condition is under control, says Dr. Parikh.)
The bottom line: EIB, or exercise-induced asthma, is a pretty common condition that can cause uncomfortable and sometimes dangerous symptoms before or after exercise. If you suspect you have EIB, definitely get it checked out by a doc. Chances are, you'll find ways to safely manage it so that you can return to your favorite Peloton class, running routine, or hot yoga flow.
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