Exercise Induced Asthma Program

Exercise induced asthma is a condition of the lungs that produces shortness of breath, wheezing, cough and/or chest tightness after exercise. Frequently the symptoms come on 2 to 5 minutes after exercise and then may persist until you have to stop exercising.  In milder forms of the condition, a person can continue to exercise in spite of the symptoms, which go away after a number of minutes.

Diagnosing Exercise Induced Asthma (EIA)

Exercise induced asthma is caused by a narrowing of the bronchial tubes. To determine if you have exercise induced asthma, our expert team of doctors may conduct lung function tests or peak flow measurements before and after exercise.

A number of other medical conditions can mimic EIA. These include emphysema, fibrosis or scarring of the lung and heart problems. Part of your evaluation will be designed to rule out these other problems. Sometimes the pattern of your symptoms and your response to medication can help to rule out these other problems. 

Exercise Induced Asthma Treatments

Exercise induced asthma can be treated successfully in most asthmatics and does not restrict your ability to exercise.  This is especially true if your baseline lung function is normal.  The treatment of EIA can be divided into two aspects: long term prevention and short-term treatment.

Long term prevention:

Unless the EIA is very mild or requires only intermittent treatment, some attention needs to be given to long-term prevention.  Chronic inflammation of the airways is a primary defect of asthma, which leads to EIA and other forms of “twitchy” or reactive airways. 

An important cause of airway inflammation is exposure to allergens in the air to which you are allergic.  Reduction in the level of allergens in your environment will result in long-term improvement in your EIA that may not be evident in the short term. Part of your evaluation will be directed at defining the allergens to which you are allergic and developing ways to reduce your exposure to them.  Cortisone sprays used on a regular “preventative” basis can gradually improve EIA over a period of weeks or months (these sprays are sometimes called “controller medication”).  

Short term treatment:

The most common treatment for EIA is bronchodilator inhalers such as albuterol (Ventolin, Proventil), levalbuterol (Xopenex) or pirbuterol (Maxair).  One or two puffs of one of these sprays can be used 5 to 10 minutes before exercise as a short-term prevention or can be used after exercise when the symptoms occur.  The response usually occurs within minutes.  As a general rule if you do not get complete relief within 5-10 minutes or if the symptoms recur within several hours then other kinds of treatment should be added or substituted. 

Long acting bronchodilator drugs such as salmeterol or formoterol can be effective if the effect of short acting preparations wear off too quickly.  One inhalation of these should generally be taken one half to one hour before exercise.  These long acting bronchodilator drugs are often combined with a cortisone spray.
Another form of treatment for EIA is a class of drugs sometimes called “mast cell stabilizers,” including cromolyn (Intal inhaler) and necodomil.  They are not currently available in the US but are widely available in other parts of the world.  They are different than the bronchodilators in that they do not treat symptoms when they occur but only work when used before the exercise. 

The antileukotriene pills [zafirlukast (Accolate) 20mg 2/day, montelukast (Singulair) 10mg 1/day (5mg for age 6-12)] when used regularly or before exercise can result in an improvement in exercise-induced asthma in some people.

To make an appointment for an exercise induced asthma evaluation or treatment plan, please call 617-636-5333.