What Is Exercise-Induced Bronchoconstriction (Formerly Known as Exercise-Induced Asthma)?

• EIB with asthma refers to airway constriction (narrowing) or breathing problems that are triggered by exercise or strenuous activity in people with asthma (some people with asthma experience asthma symptoms only during exercise).

  [4]

• EIB without asthma refers to EIB symptoms that develop in people who do not have underlying asthma.

  [5]

Symptoms of EIB are similar to those of chronic asthma, including:

• Persistent cough
• Shortness of breath
• Wheezing (a whistling sound when breathing)
• Chest tightness or pain
• Decreased performance or stamina
• Fatigue during exercise

These symptoms typically follow a specific timeline or pattern. Symptoms may:

• Start approximately 5 to 8 minutes after onset of exercise (sometimes within just a few minutes) and peak within 10 to 15 minutes

  [5]

  [6]

• Improve or completely resolve within 30 to 90 minutes of exercise
• Not return for a “refractory period” of one to three hours, even if you exercise again during that time

Certain risk factors can increase your chances of experiencing EIB or worsen EIB symptoms, including:

• Cold, dry air
• Air pollution
• High pollen counts
• High ozone levels
• Irritants like smoke and strong fumes, including from chlorine in swimming pools
• Respiratory infections
• Poorly controlled chronic asthma or recent asthmatic episode

  [1]

• Being out of shape

  [10]

• Soccer
• Basketball
• Long-distance running or cycling
• Ice hockey or skating
• Cross-country skiing

Diagnosis of EIB begins when your healthcare provider gathers information about your symptoms, overall health and physical activity, and family history. They will then conduct various tests, including:

• Spirometry, a breathing test in which you blow into a machine to check your lung function
• Exercise challenge test, the primary diagnostic test for EIB, in which you run on a treadmill or pedal a stationary bike for up to 10 minutes and then do more breathing tests

  [5]

• Allergy tests to determine if any triggers could be making your symptoms worse

If exercise testing isn’t possible or the results are unclear, doctors might try other tests, such as:

• Hyperventilation test, in which you breathe quickly into a machine
• Airway provocation tests, which involve inhaling substances like methacholine or mannitol that can trigger bronchial constriction in some people with sensitive airways
• Nitric oxide test, in which you breathe into a machine that measures airway inflammation (this test is especially useful for kids because of its ease of administration)

Your healthcare provider may recommend other tests to rule out other potential causes of your symptoms, such as chest X-ray to identify respiratory infections and laryngoscopy (a camera inspection of your throat) to assess gastroesophageal reflux or any other kind of throat obstruction.

Short-Term (Rescue) Medications

These medications:

• Include inhalers like albuterol (Ventolin) and levalbuterol (Xopenex)

  [12]

• Are taken 10 to 15 minutes before exercise to prevent symptoms for up to four hours

  [13]

• May become less effective over time as tolerance to the medication builds

  [5]

About 15 to 20 percent of people who have EIB with asthma will not respond to SABA treatment alone, necessitating other treatments and strategies.

Long-Term (Controller) Medications

• Experience more frequent or severe symptoms
• Engage in prolonged exercise or exercise multiple times or day
• Are children who have an irregular schedule or engage in vigorous play at various times

These medications may include:

• Inhaled corticosteroids, which help relieve bronchial tube narrowing and inflammation
• Leukotriene receptor antagonists (LTRAs) like montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo), which help prevent bronchoconstriction, inflammation, and mucus production and are not associated with tolerance
• Antihistamines, which are recommended for athletes and people who have allergies or experience frequent symptoms despite using SABAs or LABAs

Inhaled corticosteroids and LTRAs are considered a first-line treatment for people who have EIB without asthma.

In addition to medications, there are various steps you can take to prevent EIB symptoms.

The following practices can help to prevent episodes of EIB.

• Warm up for 10 to 15 minutes before calisthenics (movements that use body weight for resistance) and stretching exercises. Aim to achieve a heart rate around 50 to 60 percent of your maximum.

  [3]

• Breathe through your nose during workouts as much as possible to warm and humidify air.
• Use a scarf or mask in cold weather to warm and moisten the air you breathe.

  [6]

• Avoid your known asthma triggers and outdoor workouts in environments with high pollen, ozone, chlorine, or pollutant levels.
• Drink caffeine before exercising, which may reduce bronchoconstriction.
• Follow a low-sodium diet.
• Practice breathing control techniques, including yoga, to reduce symptoms and medication use.
• Engage in cooldown stretches for 5 to 10 minutes after a workout to prevent symptoms.

  [14]

To stay active and comfortable with EIB:

• Be mindful of air quality levels and temperatures.
• Favor humid indoor environments for exercise.
• Limit exercise while you have a respiratory infection.

  [10]

• Manage your stress, which can increase inflammation, including of the airways.
• Keep an accurate record of your inhaler use and review it with your healthcare provider at least once a year.

  [6]

If possible, stick to activities and sports that are less likely to trigger asthma symptoms, including:

• Walking
• Leisurely or short-distance biking
• Hiking
• Weight lifting

  [1]

• Baseball

  [16]

• Football
• Wrestling
• Gymnastics
• Surfing
• Swimming (unless the pool is highly chlorinated)

• Limitations or even avoidance of physical activity, which affects fitness and mental health, including in children
• Poor academic or job performance, especially in physically demanding roles
• Severe symptoms, including significant asthma attacks or breathing difficulties that may require emergency care

Exercise-induced bronchoconstriction affects:

• 40 to 90 percent of people with asthma

  [5]

• 5 to 20 percent of people without asthma

  [4]

• 30 to 70 percent of elite athletes, with higher rates in women and those who play winter sports

• EIB is a common but manageable condition. With the right diagnosis and treatment plan, it shouldn’t prevent an active lifestyle.
• Symptoms like wheezing and shortness of breath during exercise should never be ignored and should be discussed with your healthcare provider for accurate diagnosis and treatment.
• Preventive inhalers, long-term medications, proper warm-up and cool-down routines, trigger avoidance, and lifestyle changes can help you stay active and symptom-free.