Teens: Being a Sport with Exercise - Induced Asthma

by Food and Drug Administration (FDA)

You wouldn't call Nicholas, 16, a jock. He harbors no dreams of Olympic glory, has no intention of trying out for a school sports team, and has faked more injuries to get out of gym class than even he can count. His hobbies run more to the creative and intellectual — playing bass guitar in a garage band and fooling around on his computer.

But Nicholas (who asked that his last name not be used) didn't always avoid sports. At one time, he was an avid basketball player. But all that changed about four years ago.

"We were supposed to run a mile in gym, and about halfway through, I started coughing, wheezing and felt nauseous. I told the teacher I couldn't go on, but he said that he didn't like quitters. I tried to finish, but I couldn't," he recalls. Nicholas went to the doctor and found out he had exercise-induced asthma.

"My friends stopped inviting me to play B-ball or soccer after school because they were afraid that I would have an attack in the middle of a game. Some of the kids called me 'wheeze boy'," Nicholas says. "After a while, I decided they were right, so even though I loved sports, I gave up on all physical activities."

Asthma is a lung disease that is either inherited or may develop as a severe allergic reaction to pollen, viruses, dust, cigarette smoke, and other "triggers" (but not everyone with allergies develops asthma and not every asthmatic has allergies). Exercise-induced asthma (EIA) is a common form of asthma. It occurs only when a person exercises. People who have chronic asthma, on the other hand, can develop symptoms whenever they are exposed to a trigger.

About 80 to 90 percent of people who have chronic asthma also have EIA. But you can have EIA even if you don't have chronic asthma. Nicholas is among the 35 to 40 percent of people with seasonal allergies who have EIA, and his symptoms are always worse during the spring and fall when gym classes are held outdoors.

How an EIA Attack Happens

During an asthma attack, the bronchial airways (the large and small tubes that bring air into the lungs) become partly blocked. A trigger, such as pollen, causes immune system cells in the lungs to release histamine and other chemicals. These chemicals cause the lining of the airways to swell, making them narrower. At the same time, tiny rubberband-like muscles wrapped around the outside of the bronchi (the two large tubes that branch out from the windpipe into the lungs) tighten in what is known as "bronchospasm." Completing the process, mucus cells in the airways produce secretions that plug up the works even more.

In about half of chronic asthmatics, the initial attack (known as "early response") is followed by a delayed reaction ("late response"). This delayed reaction happens because lung inflammation makes the airways and lungs extremely sensitive to irritation. Some asthma specialists believe that EIA differs from chronic asthma because exercise-induced bronchospasm (another name for EIA) does not cause lung inflammation, so there is no late response.

With asthma, the problem isn't getting air into the lungs, but exhaling air out through the obstructed airways. (People who don't have asthma can get an idea of what an asthma attack feels like by taking a breath and holding it for a second, then trying to take another breath without exhaling first.)

Cold, dry air is believed to trigger EIA. So, exercising outdoors in the winter or breathing through your mouth during heavy exertion is likely to set off an attack. (Breathing through your nose warms and moistens the air before it reaches the lungs.) EIA symptoms typically occur after three to eight minutes of strenuous activity, and can last 20 to 30 minutes. They can range from mild to severe, and include coughing, wheezing, tightness or pain in the chest, shortness of breath, and reduced stamina.

EIA Need Not Bench You

"Many people who have EIA don't know it because they blame their symptoms on being out of shape," notes John Weiler, M.D., a professor in the department of internal medicine at the University of Iowa Hospitals and Clinics in Iowa City. Others may experience symptoms only when they push themselves to the "max" or exercise outdoors when air quality is poor.

But if you're susceptible to it, EIA can affect you, regardless of your fitness level or athletic ability. In fact, according to various studies, 10 to 12 percent of athletes have EIA. At the 1984 summer Olympics in Los Angeles, 67 of the 597 members of the American team had EIA; among them, they won 41 medals.

Obviously, EIA need not limit participation or success in vigorous activities. Today it can be medically managed and its effects minimized.

"In the past, doctors discouraged people with asthma from exerting themselves to avoid triggering an attack. But the current thinking is that it is important for asthmatics to engage in regular exercise to condition and strengthen their lungs," says Stanley Szefler, M.D., director of clinical pharmacology at the National Jewish Center for Immunology and Respiratory Medicine in Denver.

About the Author

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