Preventative Tips to Stay Active with Exercise-Induced Bronchoconstriction (EIB)

Written By: Sahannah Seemungal

Exercise-induced bronchoconstriction (EIB) occurs when high-intensity aerobic training within as soon as 15 minutes triggers the narrowing of the airways in your lungs, leading mild to moderate asthma-like symptoms including shortness of breath (dyspnea), chest tightness, mucus production, wheezing, and cough. Between 40% to 90% of individuals with asthma experience EIB, but even those without clinical asthma diagnosis are not immune as up to 20% of the general population experience EIB as well. The condition is especially common in elite athletes, particularly those in winter and pool sports, and among women, if not properly managed.

Individuals diagnosed with asthma tend to avoid exercise to prevent their symptoms from occurring. However, this is not the most effective strategy because regular physical activity is a key part of maintaining overall health, and avoiding exercise can lead to negative consequences such as social isolation in adolescents, obesity, and poor general health. In fact, research shows that regular exercise can improve EIB severity, pulmonary function, and reduce airway inflammation in people with asthma and EIB. Rather than eliminating exercise altogether, individuals should focus on strategies to manage symptoms effectively so that they can continue participating in activities they enjoy.

There are several evidence-based strategies that can reduce the risk of EIB symptoms during exercise. For example, wearing mechanical barrier masks during workouts in environments with high levels of pollen, allergens, or pollution causing poor air quality can help prevent inhalation of irritants that may trigger symptoms. Also, because high concentrations of chlorine in pools can induce EIB, it is advised to choose facilities with alternative disinfection methods or those with good ventilation like outdoor pools. In cold, dry environments, it’s recommended to either avoid aerobic exercise or cover your airways with a scarf, as these conditions are known to precipitate EIB in susceptible individuals.

Interestingly, EIB symptoms usually resolve spontaneously within 30 to 90 minutes and induce a refractory period of 1 to 3 hours, where continued exercise does not trigger airway narrowing. Therefore, many researchers, athletes, and trainers often recommend implementing a proper warm-up before engaging in vigorous activity. This should include exercises close to peak oxygen consumption or maximum heart rate to intentionally trigger the refractory period. Jumping straight into high intensity activity can shock the respiratory system. Thus, warming up gradually helps the lungs adjust by increasing breathing rate and airflow, essentially reducing the likelihood of sudden airway constriction. 
 

While these strategies are beneficial, medications are essential for managing symptoms for all patients with EIB. For example, the American Thoracic Society (ATS) strongly recommends the use of a short and long-acting [beta]2-agonist and inhaled corticosteroids. It is important to consult with a healthcare provider to determine the best medication regimen, as treatment needs vary from person to person.

While it may seem counterintuitive to encourage exercise when it can trigger bronchoconstriction, effective symptom management makes it possible. Regular physical exercise has numerous advantages, from reducing the incidence of chronic illnesses and strengthening the immune system, to releasing 'feel-good' endorphins and maintaining a healthy weight. Instead of abstaining from exercise, individuals with EIB should focus on proactive symptom management strategies, such as warming up, using prescribed medications, and choosing appropriate environments, to stay active and reap the benefits of a healthy lifestyle. 

References:
 

Cleveland Clinic. “Exercise-Induced Asthma (Exercise-Induced Bronchoconstriction).” Cleveland Clinic, 13 Dec. 2023, https://my.clevelandclinic.org/health/diseases/4174-exercise-induced-asthma.
 

Jayasinghe, Harshani, et al. "Asthma Bronchiale and Exercise-Induced Bronchoconstriction." Respiration, vol. 89, no. 6, 1 June 2015, pp. 505+. Gale Academic OneFile, dx.doi.org.adelphi.idm.oclc.org/10.1159/000433559. 

Parsons, Jonathan P., et al. “An Official American Thoracic Society Clinical Practice American Journal of Respiratory and Critical Care Medicine, vol. 187, no. 9, 2013, pp. 1016–1027. PubMed, https://pubmed.ncbi.nlm.nih.gov/21811185/.

Siafakas, Nikolaos, and Nattapol Vichyanond. “Exercise Induced Asthma.” StatPearls, StatPearls Publishing, 30 Mar. 2023, https://www.ncbi.nlm.nih.gov/books/NBK557554/.