Asthma and exercise

Everyone should exercise. However, exercise can trigger asthma symptoms in some patients (exercise-induced asthma). Indeed, some of us only have symptoms of asthma during exercise. However, good control and following a few basic rules should allow you to exercise normally. Even professional athletes can suffer from asthma, but it has not held them back. Such athletes include Tour de France winner Bradley Wiggins, the women’s marathon world record holder, Paula Radcliffe, and our very own Olympian, swimmer Welson Sim. 

Exercise has two important roles in the context of the lungs. It allows you to increase your stamina and lung function, thus allowing you to do more and increase your fitness. Secondly, it helps maintain an ideal body weight. Patients who are overweight or obese tend to have asthma that is more poorly controlled.

Exercise-induced asthma can affect anyone - children to adults, recreational to professional players. It is more likely to be detected and cause problems in endurance sports such as long distance running and cycling. It is also dependent on the nature of the sport - those exposed to cold air, pollution and chemicals during activity are more like to develop symptoms. For example, swimmers are constantly exposed to chemicals in the pool and cyclists may be affected by air pollution.

There are various theories as to why exercise causes asthma attacks. One that as people breathe faster when they exercise, the air taken in tends to be colder and drier (as the nose is usually bypassed) and this combination is thought to act as a trigger.

For most people, the most pragmatic way of diagnosis is recognition of symptoms that develop during exercise. These may include ‘typical’ symptoms of asthma such as shortness of breath, coughing, tightness in the chest and wheezing. These usually resolve after rest or the use of the reliever inhaler.

Some may require a more objective and accurate diagnosis, particularly professional athletes - the use of asthma medicine may affect their ability to compete.  Investigations may include challenging the airways with agents to look for sensitivity of the airways and testing during exercise.

When exercising, you should increase the level of work at a slow and steady pace. Inform your trainer and friends about your condition so that they can provide assistance if necessary.

Warm up before exercise
Warming up prior to exercise is known to help decrease the level of asthma attacks and should be done by patients.

Avoid triggers
Avoiding contact with other triggers will also help prevent a more severe asthma attack.

Taking medication as necessary
The most important thing is the regular and appropriate use of your asthma medicines. If exercise does indeed cause symptoms, the reliever inhaler should be used prior to warming up and should also be carried during exercise. You should stop exercising if you develop significant symptoms, at which point resting and taking another puff of the reliever inhaler should lead to improvement.

Medication for greater asthma control
Inhaled steroids and montelukast are more commonly used for greater control. Evidence has emerged suggesting that there may be a role for the use of combination inhalers (inhaled corticosteroids + Long acting bronchodilators) in the control of exercise-induced asthma. Your doctor will be able to advise you more on this.

The International Olympic Committee insists on clinical and laboratory evidence of asthma in professional athletes who need to use their inhalers during competition. The World Anti-Doping Agency provides guidance on the use of medicines in the context of exercise-induced asthma. Some may require special permission in order to be used. These are issued by doctors familiar with the standards.

A minority of patients with asthma may develop symptoms during sexual intercourse. Sexual activity can increase the speed of breathing and patients can also be exposed to other triggers. Poorly controlled asthma may also increase stress levels involved (e.g. if you are focused on controlling your cough).

As always, good control of asthma will lead to less problems. Sex should be treated like a form of exercise - using a reliever inhaler beforehand and keeping it accessible may be useful. It is also important to be aware of the possibility of latex allergy, as most condoms contain latex.