Exercise Induced Asthma (EIA) - Causes, Diagnosis and Treatment

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Your sports medicine physician may recommend an exercise challenge. This test involves blowing into the spirometer, exercising hard enough and long enough to cause symptoms.

Asthma is a common condition in the general population, estimated to affect 13-20 million people in the US. Some athletes who have never had asthma can develop what is known as “Exercise-Induced Asthma” (EIA) or “Exercise-Induced Bronchospasm” (EIB). These people develop shortness of breath, wheezing, or coughing either during or shortly after exercise. Sometimes the condition may go undiagnosed, as the only symptom can be a cough after exercise, which the athlete may not recognize as having anything to do with asthma.

The diagnosis of EIA can be challenging. Some people may only have symptoms when exerting themselves at a competitive level. Some people may only have symptoms when they are exercising while being exposed to a specific allergen, when running in a certain area, or swimming in a certain pool. EIA is also much more common with cold dry air.

If you go to see your sports medicine physician about possible EIA, he or she will probably ask questions not only about your symptoms with exercise, but also about symptoms at other times, such as a cough at night, or allergies during certain seasons. He may ask at what age you first noticed symptoms, and whether you have any allergies, or any skin conditions such as eczema or atopic dermatitis, which are also associated with asthma. He will want to know if you have any family history of asthma, EIA or related problems. He will also want to know exactly what kind of symptoms you are having with exercise, when and where they occur, and what makes them better or worse. He will then probably do a brief physical (which is usually normal) and may also do a test call “spirometry” or “pulmonary function testing.”

The spirometer is a meter that you blow into as hard and as fast as you can, measuring the air coming out of your lungs and determining whether or not the rate is normal for someone of your sex, age, and height. For most athletes with EIA, this test is normal, but may be decreased after exercise. Your sports medicine physician may recommend an exercise challenge.

This test involves blowing into the spirometer, exercising hard enough and long enough to cause symptoms, then checking the spirometry again every 5-10 minutes for the first 30 minutes after exercise to see if there is any evidence of evolving airflow obstruction. Sometimes this test is done by running on a treadmill or riding a stationary bike in the clinic. For people who only have symptoms with certain conditions (such as a high level of exertion in cold air) this exercise challenge may need to be done at the training or competition site where symptoms are known to take place, as the test in the climate controlled clinic may be completely normal,.
 

There are now many hand-held models of spirometers that physicians can take to the field to test athletes before and after training. If a spirometer is not available, or the physician is not able to attend the training or competition, he or she may give you a “peak flow meter” to use before and after competition or training that you can learn to use yourself. Usually a nurse in the physician’s office can show you how to use the peak flow meter and record the results. After recording the results for a number of practice sessions and/or competitions, you can bring the results back to your physician.

If there is any evidence of Exercise Induced Asthma, your physician may prescribe an inhaler called a “bronchodilator” for you to use before exercise that will prevent your symptoms. He can also talk to you about how to minimize your chances of having symptoms with exercise.

So, if you notice difficulty breathing, coughing or wheezing during or after your winter workouts, you may want to talk to your sports medicine physician. EIA is one of the possibilities, but there are also other conditions that cause similar symptoms such as vocal cord dysfunction, some types of gastric reflux, and certain allergies that can also be screened for.

Rochelle Nolte, M.D.
Member AMSSM

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date: March 5, 2006