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Q: How can I prevent coughing, wheezing, and chest tightness after exercise?
A: Exercise-induced bronchospasm (EIB) can be prevented in everyone. Exercise is just as important for people with asthma as it is for others. However, breathing relatively cold air triggers bronchospasm in most people with asthma. The airways become dry and they respond by narrowing (bronchospasm). Symptoms of cough, wheezing, chest tightness, and/or shortness of breath start about 5 minutes after the exercise stops and last for about 45 minutes (unless treated by using a rescue inhaler like albuterol). About 10% of athletes, even those who successfully compete in the Olympics, have EIB. The good news is that it can almost always be prevented.
Strenuous exercise in cold air is the most potent EIB stimulus, such as cross-country skiing. Swimming rarely causes EIB since you are breathing warm and humid air while swimming. When walking in the winter cold, keep your nose open (by treating rhinitis, perhaps using nasal lavage) so that you can breathe through it. Breathing through your nose warms and humidifies the inspired air, thereby reducing the chance of EIB. If running in cold weather, try wearing a scarf over your face or a heat-exchanger mask. Exercise in polluted air (ozone or smog) and during the pollen season (if you are allergic to grasses, weeds, or trees) will increase the chance of EIB.
Either a very leisurely (15 minute) warm-up, or short sprints of 30 seconds each (with 2.5 minute breaks between each sprint) prevents EIB for about 20 minutes for some athletes. A single 3 minute warm-up probably won't work. If posible, end your exercise with a 15 minute cool-down rather than stopping abruptly. For half of those with EIB, there is a 30-90 minute "refractory period" following the first round of exercise. During this refractory period, EIB is less likely or less severe. Taking aspirin or NSAID pain pills will block the beneficial refractory period.
Most people with asthma who exercise regularly will need medication to effectively prevent EIB. Faithfully take your asthma controller medications every day to stay in the green zone of good asthma control. Starting with good lung function (in the green zone) makes EIB much less likely. Avoid exercise when you have fallen into the yellow zone.
Albuterol and cromolyn inhalers block EIB for a few hours in about 3/4 of asthmatics. Monteleukast (Singular) or a long-acting bronchodilator (salmeterol, Serevent, or formoterol, Foradil) block EIB for up to 12 hours in about 3/4 of asthmatics. Albuterol and formoterol start their protection within ten minutes, but you have to wait 20 minutes after taking monteleukast or salmeterol before you start to exercise.
You’ll know whether or not a medication works for you to prevent EIB after the first dose. It is impossible to predict which of the 4 types of EIB preventers will work for a given individual -- you just have to try them. The best way to tell which one is better is use it and then measure your drop in peak flow ten minutes after a given amount of exercise. Most people start with albuterol (Ventolin or Proventil), since they also carry it as a rescue inhaler.
Cromolyn (Intal or Tilade) is traditionally the second most popular EIB prevention medication, and the combination of albuterol plus cromolyn is almost 100% effective. Cromones act by preventing airway Mast cells from "spilling their guts" when airways get cold and dry. A big advantage of cromones is a lack of side effects. Disadvantages are the need to carry around a second inhaler, and it often takes longer to act. Three long-acting drugs are now available which may block your EIB for 8-12 hours: Singulair (monteleukast, with virtually no side-effects), and the long-acting bronchodilator (LAB) inhalers Serevent (salmeterol) and Foradil (formoterol). If you take one of these LABs every day, you must also be taking an inhaled corticosteroid, otherwise your asthma is likely to become worse.
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