What is Exercise-Induced Asthma, or EIB?

Exercise-induced asthma, now called exercise-induced bronchoconstriction (EIB), is a condition characterized by the narrowing or squeezing of the airways during physical activity. The preferred term is EIB, because the traditional name incorrectly suggests that exercise causes asthma.

According to the Asthma and Allergy Foundation of America (AAFA), 90% of people with asthma also have EIB. However, individuals who do not have asthma or other allergic diseases can also experience exercise-induced bronchoconstriction.

The good news is that the majority of people with this condition can still engage in regular physical activity, provided they manage their exercise-induced symptoms. Common strategies involve taking preventive asthma medications before symptoms start and altering exercise patterns, particularly when air quality is poor.

In this article, we will cover the symptoms, causes, and treatment of EIB.

Symptoms of Exercise-Induced Asthma

Exercise-induced asthma symptoms differ from traditional asthma symptoms.

EIB symptoms appear shortly after the start of physical activity and may persist for 10–15 minutes following the completion of a workout routine. Conversely, typical asthma symptoms can manifest when a person is exposed to environmental conditions or airborne contaminants, even if they are at rest. Some of the most common EIB symptoms include:

  • Decreased endurance
  • Chest tightness
  • Coughing or wheezing
  • Shortness of breath
  • Sore throat
  • Upset stomach
  • Reduced athletic performance

This condition also can cause young children to develop an aversion to strenuous physical activity. This is understandable, since such activity can be difficult and taxing on those suffering from induced asthma.

As you can see, exercise-induced asthma can lead to a wide range of symptoms. However, a few other conditions can also cause you to experience these symptoms.

Consult a licensed healthcare provider to determine whether you are experiencing EIB or another condition. They will be able to help you determine the root cause of your symptoms and recommend potential interventions.

By proactively mitigating the effects of EIB, you can participate in the forms of exercise you enjoy and maintain an active lifestyle.

Causes of EIB

EIB and the subsequent airway constriction can be linked to several sports-specific airborne irritants, such as:

  • Air pollution while cycling, running, or walking
  • Chlorine while swimming
  • Cold, dry air when playing ice hockey

Additionally, you could experience EIB symptoms if exposed to paint fumes, cleaners, perfume, or other airborne substances while working out in the gym.

For years, it was believed that cold weather set off exercise-induced bronchospasms. However, more recent research suggests that it is the dryness of the air that triggers EIB, not the temperature. Cold air is typically drier than warm air — consequently, it quickly dries out your bronchial tubes, restricting airflow.

Sports that are less taxing or include short bouts of exertion are less likely to cause symptoms. Examples include hiking, recreational biking, walking, baseball, football, golf, and wrestling. Short-distance track events (e.g., sprints or shuttles) also fall into this category.

However, sports that require continuous exertion, especially in cold dry air, such as ice hockey, ice skating, cross-country skiing, cycling, long-distance running, basketball, and soccer, have a higher likelihood of causing EIB symptoms.

Diagnosis of EIB

Exercise-induced asthma can be challenging to diagnose, especially in people who are very athletic. The symptoms resemble the way most anyone might feel after vigorous activity or even regular exercise. Elite athletes might attribute subpar athletic performance to controllable factors like sleep or diet. However, EIB could be the problem.

An allergist can assess your symptoms to determine whether they are exercise-induced, allergy-induced, caused by airborne contaminants, or are a manifestation of underlying asthma.

During the examination, the provider will review your medical history. They will likely gather specifics about your routines, including how often you exercise, where you tend to work out, and what specific activities you engage in.

Depending on their findings, they may also consider conditions that can worsen symptoms of EIB, such as upper respiratory problems.

One common test involves connecting you to a spirometer, a device that measures how much air you inhale and exhale. While connected to the device, you will be asked to ride a stationary bike or run on a treadmill. Unusual fluctuations in lung function may indicate that you are experiencing EIB.

Treatment and Management of EIB

Providers can prescribe a variety of medications to help treat and manage EIB. Fast-acting medications are usually taken just before exercise and include:

  • Short-Acting Beta Agonists (SABAs). SABAs are administered via inhaler and are designed to open your airways. They are not intended to be used daily, as doing so can reduce their effectiveness. Common examples include levalbuterol and albuterol.
  • This inhaled medication relaxes the airway to improve air flow and might be effective for some individuals. It is sometimes administered via a nebulizer.

Your provider might also prescribe daily-use medications that are to be taken long-term. They include:

  • Combination Inhalers. These inhalers contain long-acting beta-agonists (LABA) and corticosteroids. They may be recommended for pre-exercise use or daily use.
  • Inhaled corticosteroids. Corticosteroids reduce airway inflammation. These medications may need to be used for several consecutive weeks before a person experiences the optimal effects.
  • Leukotriene modifiers. These medicines block inflammatory activity, thereby reducing or preventing airway constriction. Depending on the provider’s recommendations, leukotriene modifiers may be used before exercise or daily.

You can also use these strategies to manage your exercise-induced symptoms:

  • Warm up for at least 10 minutes before starting your routine.
  • Wear a scarf or mask when exercising in cold weather.
  • Breathe through your nose.
  • Avoid exercising in areas with lots of air pollution (e.g., industrial districts, busy roadways).
  • Exercise indoors when pollen counts are too high.

By consulting with a licensed provider and using these tips, you can continue enjoying your favorite activities while mitigating your EIB symptoms.

Navigate EIB with Florida Medical Clinic Orlando Health

While many EIB symptoms are mild to moderate, this condition can diminish your quality of life and hinder your ability to exercise if left unchecked.

The good news is help is right at your fingertips. If you would like to request an appointment with Dr. Reichmuth or learn more about how Florida Medical Clinic Orlando Health can help with your exercise-induced asthma, please contact our team at 813.779.8194.

Meet Daniel A. Reichmuth, MD, FAAAAI, FACAAI

After graduating with distinction from Purdue University, Dr. Reichmuth received his Doctor of Medicine degree from the Indiana School of Medicine. He is board certified by both the American Board of Internal Medicine and the American Board of Allergy & Immunology. Dr. Reichmuth specializes in allergic rhinitis, sinus disease, asthma, spirometry testing and FeNO measurement, eczema and chronic respiratory infections.

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Allergy, Asthma & Immunology

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