Exercise-induced asthma or Exercise-induced bronchoconstriction (EIB) is a condition that results in difficulty in breathing after a bout of exercise or any physical activity that leads to hyperventilation and dehydration of the airway. Treatment modality for EIB depends upon the severity and also the associated symptoms of asthma if any.
Management focuses on the relief of bronchoconstriction and reduction in risk factors associated with bronchoconstriction.
Non-pharmacological ways include,
- Warm-up before any activity to induce a refractory period
- Using a heat and moisture exchanger mark to pre-warm and humidify the inhaled air during increased ventilation
- Avoid exposure to air pollutants or allergens (avoid activity in an area with increased pollution levels, pollens, high levels of chlorine)
- In severe cases, choose a sport with a lower risk of EIB, less than 5 to 8 minutes of continuous physical activity
- Avoid strenuous activities in cold weather as the low temperature can dry and constrict the airways
- Decrease body weight in obese individuals helps to improve EIB severity, lung function and reduces inflammation
- Gradual increase in physical activities levels to increase the tolerance and endurance
Along with the above-mentioned ways, some research studies have shown the efficacy of breathing exercises in managing asthma symptoms, if done under the supervision of an expert. Also, they are not being performed alone but as an add-on with pharmacotherapy to avoid any complications. Some of the common techniques are,
- Diaphragmatic Breathing
The diaphragm is a muscle below the lungs that helps with breathing. This technique helps to learn from the region around the diaphragm rather than the chest. It helps to strengthen the diaphragm and slows down breathing.
Sit straight on the chair and place one hand on the chest and one on the stomach. Breathe in slowly through the nose. Focus on the movement of hands. The hand above the stomach should move but not the one on the chest. Breathe out slowly through lips and keep practicing till breathing in and breathing out can happen without the chest moving.
- The Papworth method
Combines different types of breathing with relaxation training techniques. It teaches how to breathe in a controlled manner and slowly with the diaphragm and nose.
- Pursed lip breathing
The technique is used to relieve shortness of breath. Breathe in slowly through the nose with mouth closed and then open lips slightly (purse) as about to whistle and then breathe out slowly.
Pharmacological interventions include,
(Always to be done under the supervision of a physician)
- Short-acting beta-agonists (SABA)
Use SABA 5-20 minutes before exercise. It leads to bronchodilation that may last up to 2-4 hours. Tolerance levels can rise for SABA, so should be used judiciously.
- Inhaled corticosteroids
They are not effective when used intermittently before exercise but may take 2-4 weeks for maximal benefit and are strongly recommended for people who do not respond to SABA or use it indiscriminately.
- Leukotriene receptor antagonists (LTRA)
They may take 2-4 weeks for the maximal benefit and provide longer-lasting bronchodilation and don’t adapt to tolerance, unlike SABA.
- Anticholinergics
They block acetylcholine, a neurotransmitter that causes inflammation and increased mucus production in asthma.
Even after the non- pharmacological or pharmacological intervention, there are certain conditions in which following up with a doctor becomes necessary. Following symptoms along with EIB raises a red flag and schedule a visit with a doctor,
- Fainting
- Dizziness
- Persistent cough
- Blue lips or nails (showing a lack of oxygen)
As we have seen that EIB is triggered by an aerobic activity in general and with hyperventilation and inhalation of cold, dry air, but with certain precautions and proper supervision, a person having asthma can also stay active and indulge in regular physical activities without aggravating EIB symptoms.
Reference list
- Aggarwal, B., Mulgirigama, A. and Berend, N. (2018). Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. npj Primary Care Respiratory Medicine, [online] 28(1).
- Gerow, M. and Bruner, P.J. (2020). Exercise Induced Asthma. [online] PubMed.
- Thomas, M. and Bruton, A. (2014). Breathing exercises for asthma. Breathe, [online] 10(4), pp.312–322.
