Triathlete Magazine published October 2000

“Asthma is psychological; it's all in your head.” Unfortunately, the 12 million Americans with asthma have heard this false rhetoric all too often. For all of us who work hard every day to bring our asthma under control, these declarations are off base, insulting and often the result of mis-education. Asthma is a disease. More specifically, it is an inflammatory disorder of the lungs that causes obstruction, due to narrowing, of the bronchial tubes in the lung, and because that is not enough, there is an added bonus of mucus and fluid production. These characteristics lead to the classical symptoms of asthma, including: wheezing, coughing, chest tightness, and sputum production. Many factors act as triggers for asthma and they consist of: allergy causing materials (pollens, danders, and molds), irritants (tobacco smoke and pollution), viral infections (the simple cold), and for me, particularly exercise. Medical professionals theorize that exercise-induced asthma is due to the cooling and dehydration of our lungs that occurs with the more rapid breathing that we experience during training and racing, especially the harder workouts.

For those of us who experience wheezing, coughing, shortness of breath, and excessive chest congestion and tightness during exercise it is not because you sacked out on the couch and devoured bon-bons all winter (ok, so maybe that is part of it). Believe it or not, asthma occurs in over 10% of elite athletes. Even more baffling, after the 1992 Olympics, 23% of the Olympians were shown to have exercise-induced asthma by sensitive lung function tests. This means, they were tested in controlled conditions, it is not by self report of difficulty in breathing.

Active asthma can be the difference between a great or disappointing athletic performance. Untreated, under-treated, or uncontrolled due to the common cold or the increase in exposure to environmental allergens or pollution at certain times of the year are factors that can hinder your perfect race. Over the years, I have had several experiences which remind me that exercise (better known as exercise induced asthma, or EIA) represents just another of the many triggers for those with asthma. Even with heightened awareness of EIA, advances in medication, and education on how to properly administer inhalers, EIA represents a major challenge.

My first two experiences with symptoms of severe shortness of breath and breathing difficulty occurred when I was a swimmer, and have been retrospectively diagnosed as EIA. The first occurrence was upon completion of the 1650 yd swim at a local meet at the age of 15 when I had a cold, and the second was at the Eastern Championships as a junior in college. Another time at the end of a swim workout, I developed full blown asthma after entering a locker room newly sprayed with an insecticide. But, it wasn't until I began running as part of my exercise therapy for a shoulder injury that EIA made itself truly known. Initially, I thought I was just out of shape when I experienced chest discomfort and chest tightness after running hills. As athletes we are reluctant to admit that there is something wrong with our invincible bodies. After several of the episodes, I realized that something was wrong. I related my troubles to medical professionals who explained that, no I was not out of shape, but that I had EIA which is worsened by exposure to pollen.

I have learned that the occurrence and extent of EIA depend on the type of exercise. Vigorous running is the most likely to induce wheezing; jogging and biking are less likely to do so, while swimming is usually the least likely. Exercise-induced asthma symptoms typically start 5-10 minutes after an activity is completed, but for many of us athletes who extend our bodies and lungs past usual limits, such symptoms can and often occur during hard workouts and competitions. Symptoms usually lessen with rest, but can persist for over an hour or even lead to severe asthma attacks. Most interestingly, repeating the same exercise in less than 2 hours after suffering an exercise-induced asthma episode can lead to tolerance to further symptoms, something I’ve been told is called the refractory period of exercise-induced asthma. While this may help us continue our training, it certainly does not help us during competition, when we must prevent full blown symptoms from developing. I remember, all too vividly a few important events in which asthma hampered a peak performance (Boston Marathon, 1995; St. Anthony's, 1998; and Mrs. T’s Chicago Triathlon, 1999), causing much frustration, and scaring anyone close enough to hear my labored breathing. Over the past year I have gained a real respect and understanding of asthma and its treatment in an effort to prevent the potential negative impact that asthma would have on my performances and general well-being.

I have learned from my physicians that exercise-induced asthma can be prevented most of the time; unfortunately, a regimen that works great for three races in a row may fail on the fourth one. Treatments should be individualized to the particular athlete and the specific competition. Most importantly, prevention of EIA relies on treatment prior to exercise with appropriate medications. Management of asthma symptoms during a workout requires early recognition that they are developing and then prompt treatment with bronchodilators. Do not feel shame in stopping your workout to “catch your breath”, I do it often.

Please explore these links for detail information concerning exercise-induced asthma. After reading this summary, should you feel that you may have exercise-induced asthma or that it is not being controlled adequately, please seek assistance from a qualified allergist or asthma specialist to obtain individualized treatment. Those of us with asthma know we live with a real physical challenge; let those who claim it is merely in our minds increase their understanding and compassion and thank their lungs that they do not have it.

Train hard and have fun!

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