Run­ner's as­sthma trig­gered by no­tice­able ex­er­tion

The Progress-Index - - OBITUARIES - By Eve Glazier, M.D., and El­iz­abeth Ko, M.D.

Dear Doc­tor: I’ve no­ticed that after run­ning, es­pe­cially when I’ve re­ally pushed my­self, I’ll cough for a while. A friend says it’s some­thing called ex­er­cise-in­duced asthma. Why is it hap­pen­ing?

Dear Reader: Your symp­toms are in line with some­thing known as ex­er­cise-in­duced bron­chocon­stric­tion, of­ten re­ferred to as ex­er­cise-in­duced asthma. It usu­ally hap­pens after — but some­times dur­ing — ex­er­cise that’s vig­or­ous enough to sig­nif­i­cantly in­crease your heart rate and res­pi­ra­tion. In some peo­ple, this post-ex­er­cise pe­riod of cough­ing is ac­com­pa­nied by ad­di­tional symp­toms like a tight chest, short­ness of breath or wheez­ing. In the ma­jor­ity of cases, these symp­toms prove to be tem­po­rary and breath­ing re­turns to nor­mal.

Asthma is a chronic dis­ease in which the air­ways to the lungs be­come nar­rowed or in­flamed, which in­ter­feres with breath­ing. This in­flam­ma­tion of­ten makes peo­ple with asthma sen­si­tive to a range of fac­tors, in­clud­ing dust, mold, to­bacco smoke, pollen, pet dan­der, air pol­lu­tion, chem­i­cals, cer­tain med­i­ca­tions, ex­er­tion and cold air. Known as trig­gers, these sen­si­tiv­i­ties can cause an asthma at­tack in which the air­ways be­come even more in­flamed and symp­toms worsen. In se­vere cases, an asthma at­tack can cause air­ways to be­come fully ob­structed and can be fa­tal.

Un­like peo­ple with asthma, who have mul­ti­ple trig­gers, those with ex­er­cise-in­duced asthma ex­pe­ri­ence symp­toms only dur­ing or after ex­er­tion. Some find that their episodes are as­so­ci­ated with ex­er­cis­ing in air that is colder or dryer than nor­mal. The same work­outs that pro­duce no symp­toms in the warmer months may bring on cough­ing and wheez­ing when the weather turns cold, or when in­door heat­ing takes the mois­ture out of the air. In most peo­ple, symp­toms start five to 20 min­utes after be­gin­ning to ex­er­cise, or five to 10 min­utes after ex­er­tion has ended, and are short-lived.

Di­ag­no­sis of ex­er­ci­sein­duced asthma typ­i­cally be­gins with a rest­ing lung func­tion test. This is done with a breath­ing de­vice known as a spirom­e­ter, which mea­sures the vol­ume of your in­hale, the vol­ume of your ex­hale and how quickly you ex­pel the air from your lungs. This may be fol­lowed by an ex­er­cise chal­lenge test, like run­ning on a tread­mill, rid­ing a sta­tion­ary bike or climb­ing stairs, in or­der to trig­ger symp­toms. The ex­er­cise chal­lenge ends with an­other spirom­e­try test, which will re­veal any changes in lung func­tion.

Other con­di­tions can have symp­toms sim­i­lar to those of ex­er­cise-in­duced asthma. These in­clude al­ler­gies, chronic ob­struc­tive pul­monary dis­ease (COPD), obe­sity, gas­tro-in­testi­nal re­flux, vo­cal cord dis­func­tion, con­ges­tive heart fail­ure and cer­tain lung dis­eases. As a re­sult, we think it would be wise to check in with your fam­ily doc­tor about what’s hap­pen­ing.

De­pend­ing on his or her find­ings, your doc­tor may sug­gest us­ing an asthma in­haler or bron­chodila­tor prior to the start of ex­er­cise. Cer­tain be­hav­iors can help as well. Take time to warm up be­fore ex­er­cise, as this can help lessen symp­toms sig­nif­i­cantly. In­fec­tion plays a role in asthma symp­toms, so don’t ex­er­cise when you’re sick. If you have al­ler­gies, take note of pollen counts. Keep tabs on symp­toms and, if they get worse, see your doc­tor. The good news is that with proper man­age­ment, peo­ple with ex­er­cise-in­duced asthma can safely stay ac­tive.

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ci­ate pro­fes­sor of medicine at UCLA Health. El­iz­abeth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

Send your ques­tions to ask­the­do­c­[email protected]­, or write: Ask the Doc­tors, c/o UCLA Health Sciences Me­dia Re­la­tions, 10880 Wil­shire Blvd., Suite 1450, Los An­ge­les, CA, 90024. Ow­ing to the vol­ume of mail, per­sonal replies can­not be pro­vided.

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