Is it better to use my inhaled asthma medication before or after I work out? What sports are especially beneficial for asthma?
People with asthma can participate in many sports—as long as their asthma is well controlled! Exercise is a potential symptom trigger for the majority of people with asthma, be they adults or children, weekend war-riors or elite athletes. Studies estimate that nearly 80% of persons with a diagnosis of asthma develop one or more symptoms of cough, breathlessness, or wheezing from exercising.
Those individuals have, by definition, incompletely treated asthma. If your asthma interferes with your ability to exercise, then your asthma requires better control. Asthma specialists will make a distinction between a person with asthma in whom exercise is one of several triggers, and a person who only experiences asthma symptoms in the setting of exercise. The latter individual probably carries a diagnosis of exercise-induced bronchospasm, or EIB (reviewed in Question 36).
Remember that well-controlled asthma is compatible with a full and active lifestyle. If you do experience exercise-related symptom flares of asthma, your asthma treatment needs improvement and fine tuning. An improved treatment regimen does not automatically mean that you require additional medicine. You may require a change as simple as taking your medicine earlier in the day, or before you exercise.
Just as importantly, an improved treatment regimen does not mean that you should no longer exercise or participate in sports that you enjoy. An interesting fact about asthma and exercise is that exercise itself is a bronchodilator! With exercise, the lungs’ passages actually dilate and open up more.
Exercise is good for your lungs! You have a responsibility to report any exercise-related symptoms to your physician or asthma specialist. Your treating doctor has a responsibility, in turn, to address the emergence of exercise-related symptoms and advise you on appropriate measures and treatment.
Successful treatment of asthma always includes a prescription for aerobic exercise. A balanced exercise pro-gram, tailored to a person’s specific interests and abilities, is ideal and inherent to good health. Exercise can be separated into aerobic, flexibility, and anaerobic activities.
The first achieves cardiopulmonary fitness, the second targets the range of muscle and joint motion, and the third focuses on muscle buildup and strength. Pedaling a bicycle is an example of aerobic exercise. As you pedal faster, your heart and lungs work in tandem to provide oxygen to exercising muscles while excreting acids from the accumulating effort. Yoga is an example of a flexibility exercise.
Weightlifting is an anaerobic exercise. A good exercise regimen can incorporate a balance of all three types of exercise, with particular emphasis on aerobic activities. Studies have identified factors that tend to trigger asthma symptoms during exercise. A leading hypothesis implicates the rapid inhalation of dry, cold air as the major contributor to exercise-induced asthma.
Mouth breathing, in particular, bypasses the nasal passages, which serve to warm and moisten inhaled air before it enters the lungs.
Another contributor to exercise symptoms is obvious, but all too common: poor adherence to treatment. In other words, if you are not taking your prescribed asthma medicine and you are experiencing flares in your asthma symptoms, then going outdoors to snowshoe through the woods on your winter vacation, for example, will undoubtedly provoke additional symptoms! Make sure that your asthma is under control before exercising.
Apart from taking your medicines, you may find it useful to measure your peak flow and use the PEF value to make an objective decision about participation in sports that day.
The third factor in exercise-induced asthma relates to the type of exercise itself. Some types of exercise are especially advisable in the setting of asthma, while others are viewed as more likely to trigger asthma. In the latter category, distance running or cross-country skiing, for example, can cause symptoms of cough, breathlessness, or wheezing. Distance running, cycling, and Nordic skiing involve very good aerobic conditioning, but the activity is steady, without breaks or interruption, and includes expo-sure to the outdoors, with extremes of temperature, aero-allergens, and sometimes atmospheric pollutants as well.
Athletic activity that incorporates breaks in the intensity of exertion is less likely to cause asthma symptoms by, in a very real sense, allowing time for you to catch your breath. Examples include competitive sports such as tennis, soccer, field hockey, basketball, baseball, and lacrosse.
I encourage exercise and sports for all of my patients. The fact that distance activities have been shown in research studies to be more likely to provoke exercise-induced asthma symptoms in no way leads me to discourage my patients with asthma from cycling, running in a marathon, or cross-country skiing, if they so desire. My patients tell me what athletics they want to participate in. My job is to help control their asthma and allow them full and satisfying participation in their chosen exercise routine.
Parents sometimes want to know what sport to encourage for their child with asthma. Swimming is an excellent form of exercise for persons of any age with asthma. The warm and humid air in indoor swimming is especially gentle for asthmatic lungs and unlikely to trigger symptoms. Swimming is also outstanding aerobic exercise. It develops muscle groups symmetrically, and helps develop a healthy awareness of breathing while increasing a per-son’s overall fitness and well-being. Since swimming is not a contact sport, musculoskeletal injuries are rare.
Note, too, that swimming is a form of exercise that you never grow out of. It is truly a forever sport! Be aware that swimming in a cold atmosphere, in water that is too cold, or in a heavily chlorinated pool can trigger asthma.
Ozone treatment and disinfection of swimming pools has been commonly practiced in Europe for over 50 years, and is slowly being introduced and accepted in the United States. Swimming pools disinfected primarily with ozone have enhanced water clarity, along with greatly reduced chemical odors. The pool water is purer and far less irritating to skin, eyes, and lungs.
If you live in an area with a choice of pools, you may want to research whether any of the pools are primarily disinfected with ozone. The first commercial indoor pool in the state of New York to be primarily disinfected by ozone for example, is located at the 92nd Street Y in Manhattan.
To successfully incorporate exercise and sports in your asthma treatment, keep your asthma well controlled, consult with your physician regarding any special exercise or sport-specific required measures, and build up to your desired level of activity gradually and steadily.
Additional, more specific recommendations focus on preventive measures before each exercise session. Several inhaled asthma medications are especially useful when administered pre-ventively, shortly before exercise. The medicines include the inhaled, short-acting β2 agonists, as well as inhaled cromolyn and nedocromil. Depending on the degree of your asthma and what your maintenance treatment is, your asthma might greatly benefit from a dose of inhaled medicine before exercise.
It is far better, and medically more desirable, to take an inhaled medicine for your asthma before exercise than it is to attempt exercise and develop any combination of breathlessness, cough, chest tightness, uncomfortable breathing, or wheezing.
If symp-toms occur, chances are that you will not achieve a satis-fying workout and may even have to stop prematurely. You will then be in the position to play catch-up in your attempt to treat the emerging symptoms. If your doctor instructs you to administer two puffs of an inhaler in the setting of exercise, take the inhalations before your work-out to protect your lungs and to prevent exercise-induced symptoms.
Let’s say that you have intermittent asthma and are treated with as-needed, inhaled, short-acting β2 agonist medication. Your asthma symptoms have been extremely well controlled. You now notice that you are developing asthma symptoms on the days that you participate in an aerobic dance class.
You are then instructed to inhale two puffs of the inhaled medicine 30 minutes before your dance class to protect your lungs. The results are striking. Not only does your asthma become controlled, but now you are able to keep up with the instructor and her demanding moves.
Another clinical scenario takes advantage of the fact that the leukotriene modifier class of asthma treatment is also very helpful in the treatment of exercise-induced bron-chospasm (EIB).
A fit, young man recently consulted me because of cough. On his first office visit, he explained that he had set his sights on running a marathon. He was very knowledgeable about running techniques and had embarked on a well-planned training regimen after work and on weekends. As he continued to train, he developed an episodic cough. It turned out that my future marathoner had two diagnoses: seasonal allergic rhinitis (hay fever) and exercise-induced bronchospasm (EIB).
He was determined to achieve his goal of becoming a dis-tance runner and competing in a few marathon races. I was determined to treat his symptoms and control the EIB. I am happy to report that we both achieved our goals!
I treated him with a once-daily tablet of mon-telukast (Singulair), one of the leukotriene modifier medicines. On cold winter days, when he insisted on running outdoors despite the inauspicious weather, he premed-icated with two puffs of an inhaled, short-acting β2 agonist before his warm-up. He was happy and not coughing;
I was happy with his lung function, and he was able to compete in and finish both the New York City and Boston marathons.
In addition to inhaling any preventive and protective asthma medicine, always perform a warm-up before exercising and a cool-down afterwards. The warm-up activity takes advantage of the fact that exercise is a bronchodilator.
When you warm up, your goal is to per-form enough activity to allow the bronchial tubes to open up a bit more. Depending on your sport, you should per-form about 10 minutes of light exertion, enough to break a sweat. You could, for instance, do repeated, brief (10–30 second) sprints. Stop exercising immediately after you complete your warm-up, and then wait for at least 30 minutes before getting down to your “real” exercise.
Avoid cold air as much as possible. Cover your nose and mouth during outdoor sports in cool air to help warm the air you inhale. Some people like to wear a scarf or pull a neck gaiter over their mouth to keep warm. If you are a runner, switch to an indoor treadmill in a heated gym on very cold days.
Similarly, if you live in an area with signif-icant air pollution at certain times of the year, consider moving your workout indoors on those days. Most daily ewspapers publish measures of air quality on the weather page. If your area is subject to a day or more of atmos-pheric ozone alerts during hot, muggy summer days, pay attention, protect your lungs and move the exercise indoors. Similar advice applies if you have allergic asthma triggers such as tree or grass pollens.
If you are planning to exercise outdoors, and the atmosphere has high air concentration of specific allergens that you know trigger your asthma, use your common sense. Try to prevent an allergic flare and consider moving the activity to an indoor, air-conditioned venue.
In conclusion, well-controlled asthma is no barrier to fit-ness and sport. If you require inhaled medicine, make certain you take it before exercise, even if your PEF is normal and you feel fine. Remember to warm up and cool down. View your physician as your ally, and report any concerns you may have about exercising with asthma.
Comment:
I walk several mornings a week with a friend my own age. Although this exercise is not particularly strenuous, I always take my inhaled medication before I leave home, because we walk in the morning, when the streets are likely to be dusty, sweepers and garbage trucks are out, and, in the spring and fall, pollen and leaf particles are in the air. I’m also a regular participant in aerobic class at a neighborhood gym.
I find that a routine that includes warm-up stretches, about half an hour of more rapid movement, some weight lifting and some mat work is good for overall toning, as well as mood and relaxation. Although the indoor air of the gym is rather stuffy, I don’t need inhaled medication when I work out there.
In fact, if I’m getting over a cold and feel some tightness in the chest, I find crunches especially helpful. The curled-up position gives just enough compression to loosen some obstruction in the lungs and make breathing easier.
My daughter recommends pranayama yoga (breathing exercises) to ease asthma symptoms. We both recognize that swimming and other aquatic routines protect joints and may offer a good aerobic workout, but we also agree that we have never used a pool that does not, sooner or later, cause itchy skin, reddened eyes, and troubled breathing.