Understanding EIA

Typically, EIA symptoms start minutes after you begin vigorous activity, when the airways in your lungs become narrow and constricted. These respiratory symptoms usually reach their peak of severity between five and ten minutes after you stop exercising. In many cases, the symptoms can spontaneously resolve (without the use of a short-acting inhaled bronchodilator) within 30 minutes. Exercises that involve breathing cold, dry air, such as running outdoors or skiing, are more likely to trigger EIA than activities that involve breathing warmer, humidified air, such as swimming in a heated pool. However, a few studies have also cautioned that chlorine and other chemicals used in heated and non-heated pools seem to also act as EIA triggers in some asthmatics. Although EIA usually relates to outside activities, using home-exercise equipment or simply running upstairs can precipitate an asthma episode in some people. If you have an increased sensitivity for EIA, make sure that your doctor knows so that he can evaluate and treat your condition.

Keeping Fit Despite EIA

Although EIA symptoms occur frequently in asthmatics when they exert themselves vigorously, for certain individuals, physical activity may be the only trigger that precipitates respiratory symptoms such as coughing, wheezing, and shortness of breath. Occasionally, patients mistakenly attribute their EIA symptoms to just “being out of shape,” rather than seeking a proper medical diagnosis. However, if you’re experiencing respiratory symptoms connected to exer- cise and other types of intensive physical activities, make sure that you get a proper diagnosis. Although EIA episodes usually last for only a few minutes, they can still be frightening for many people and, as a result, could unnecessarily limit your physical activities.

Diagnosing EIA

Properly diagnosing and treating EIA usually means that you can enjoy an active lifestyle. Doctors can often prescribe medications to prevent or at least substantially reduce your EIA symptoms, thys allowing you to participate in many types of exercise and sports in spite of your asthma. 

Recieving appropriate treatment for EIA is also essential for your well-being because so many people in the United States and other developed countries simply don't get enough exercise. According to a recent report by the Centers for Disease Control and Prevention (CDC), adult asthmatics in the United States are even less likely on average to meet national recommendations for physical activity than nonasthmatics. 

I'm not suggesting you run a marathon tomorrow, but as I emphasize in many other parts of this book, staying in good physical shape can only help in managing your asthma (and other ailment) successfully. So don't let your susceptibility to EIA keep you from getting the exercise you need. Rather, consult with your doctor to find effective ways of managing your condition that can also allow you to stay in shape. 

Keeping a record of your activites and nothing when you experience asthma symptoms and what steps you normally take to relieve them can assist your doctor in developing the most effective treatment program. Becasue certain drugs are more effective in preventing and controlling EIA, when you take your prescribed medication is often just as important as what you take. Work with your doctor to determine the best time to take your prescribed medication in order to ensure that it provides maximum relief. 

Controlling EIA with Medications

In many cases, competitive athletes with asthma or EIA use inhaled cortico-steriods daily to control their airway inflammation. Many competitive athletes also add a long-acting inhaled beta-adrenergic bronchodilator daily, such as salmeterol (Serevent, Serevent Diskus) or formoterol (Foradil), and/or a short-acting inhaled beta-adrenergic bronchilator, such as albuterol (Proventil, Ventolin), prior to exercise or athletic events. 

To prevent EIA, your dotor may recommend that you inhale your does of prescribed short-acting beta-adrenergic bronchodilator 15 to 30 minutes before you begin to exert yourself. The long-lasting bronchodilators salmeterol - available in dry-powder inhaler (DPI) formulation as Servent Diskus or as Servent MDI in a metered- dose inhaler (MDI) - and formoterol, available only as a DPI as Foradil Aerolizer, may be prescribe these medications as part of combination therapy with inhaled corticosteroids. 

Other long-term controller drugs that doctors also prescribe to treat EIA symptoms include cromolyn (Intal) and nedocromil (Tilade), which are both inhaled mast cell stabilizers. These products are also usually best taken 15 to 30 minutes before exercising. Recent studies have shown that when taken regularly, montelukast, a leukotriene inhibitor, may also be an effective long-term, preventive treatment for EIA.

Excerpted from "Asthma for Dummies" by William E. Berger, MD