Exercise-Induced Asthma: Do You Have to Quit Cardio?
My boss and I were driving around, in between work sites, and he was telling me the story about the last time he fought professionally. He was tired, not feeling so great, and most significantly – not mentally up to the task. His heart simply wasn’t in it anymore and he had been contemplating retirement in the weeks leading up to the match.
But, as it is, he stood in a ring, the Honduran light-heavyweight champ, readying himself to beat the brakes off of his opponent because it was his job.
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As the fight commenced, he knew he was tired, but something else was happening. His body wasn’t cooperating as it usually did. His punches were sloppy and nothing was connecting as sharply as it should have, whether he was fatigued or not. Even simple drills he could do in his sleep were not coming easily.
His opponent threw a kick and my boss fell on top of him in a drunken bit of luck. Somehow, he sloughed off to the side and put his opponent in a choke hold. But, as with everything else that wasn’t quite working out, the choke wasn’t finishing the job. His corner began yelling at him to go for another maneuver. He saw them, he heard them, but he couldn’t comprehend them.
He vaguely knew something was wrong, but with all the lights and noise and adrenaline, he could neither articulate it or stop himself. And worse, he couldn’t seem to catch his breath.
He ended up winning the fight, but as he put it, was swaying and stumbling around the ring afterward “gasping and wheezing like an old man.” At one point, a pretty female fan shouted “I love you!” to him, and he responded by yelling unintelligibly back at her and doubling over.
“I thought I was saying I love you too!” He explained, “but I definitely was not.”
His corner made him sit on a stool and he said his skin was grey and his lips were purple. He couldn’t breathe and everyone was yelling at him. Finally, a friend of his who happened to have asthma went up to the cage to see what was going on and recognized the scene immediately. He passed his inhaler to my boss’s coach and he was able to use it and recover.
“I was having a full-blown asthma attack. And when I went to see my doctor, he asked me about my training and told me I ruined my lungs.” My boss now has Exercise-Induced Asthma (EIA). Aside from being a professional MMA fighter, he is also a combat veteran who has spent most of his teenage and young adult life training at very high intensity, without much rest or adequate recovery.
Now, he runs a remodeling company and his job has dictated his fitness levels ever since. He’s getting older, like most of us, and we talk a lot about retaining our fitness during middle age.
But how can we do this effectively, with an asthma attack looming around the corner? And what causes this type of asthma? Can we do lung damage by working out too hard, too often? Or is it something that was always there, waiting to be exacerbated one day?
What Causes Exercise-Induced Asthma?
Exercise-Induced Bronchcoconstriction (EIB) is the proper term for asthma symptoms brought on by exercise. Nearly all asthma sufferers will trigger their symptoms by exercising, however, there is a smaller subset of people who have no clinical asthma, yet will experience an episode only when they exercise.
Actually, what happens is not exactly asthma. EIB is unlike real asthma because the airways do not swell. They are not affected by mold, pollen, or other irritants.
Yet, for some reason, the bronchial passageways go into spasm, and the symptoms – shortness of breath, wheezing, chest pain, and coughing – are the same as a real asthma attack. This is because the spasms narrow a person’s airways, much like a real asthma attack.
Symptoms usually start within ten minutes of working out and can last for twenty to thirty minutes post workout.
13% of the population has this issue, including some professional athletes.
Dry and/or cold air seems to have a lot to do with it. As you breathe heavily, you begin to use your mouth to take in more oxygen. Unfortunately, mouth breathing removes the moisture from the air and does not filter dust and pollutants like your nostrils do.
The result is very dry, unfiltered air, which can cause a hyper-responsiveness and spasm in your airways. Cold air sports tend to be higher risk, along with drier climates. Long-duration activities, such as running, soccer, cycling, and hockey will trigger more response than short bursts of activity, like gymnastics or sprints.
Doctors aren’t precisely sure why some people are susceptible, only that they are. It may not be common, but it is normal and very manageable.
Diagnosing EIB - Exercise-Induced Bronchcoconstriction
If you happen to be struggling after a workout, it is important to check in with your Doctor, so you can diagnose the issue. It could be a mild response called “track hack” or “runner’s cough,” which is a fairly common response to heavy cardio.
The symptom is, you guessed it – a cough. It lasts for fifteen to twenty minutes after a cardio barnburner. Track hack shouldn’t be painful or wheezy. It should just feel like a bit of phlegm you can’t get up. There should be minor to no discomfort. I get it occasionally, and it is not alarming.
If it is worse than that, you should get tested for EIB. If you experience chest pain with a cough or feel like you can’t catch a deep breath, something more may be going on. A full history is taken and your breathing will be tested before, during, and after a physical activity. If you are diagnosed with EIB, you will most likely be given an inhaler to prevent symptoms.
If you experience a severe event, or if your bronchial discomfort flares up at other times besides cardiovascular exertion, you may actually have asthma. If the inhaler doesn’t help, make sure you go back to the doctor, because it is probably more than EIB.
The Link Between Bronchial Hyperresponsiveness and Elite Athletes
Interestingly, there is a significant percentage of elite athletes who either have or develop a type of EIB, or bronchial hyperresponsiveness (BHR.) In fact, over twenty percent of Olympic Athletes have asthma or EIB. Is this natural response to heavy stimulus? Or an occupational hazard?
The first possibility, and probably the easiest correlation, is the amount of heavy breathing elite athletes do in all kinds of environments. As we learned earlier, gulping in dry, unfiltered air is a trigger. These athletes squeeze that trigger harder and more often than most casual gymgoers. Therefore, their risk of EIB would be higher than in groups of people who don’t do much heavy breathing.
On top of that, you have water loss. Typically, when you are breathing, your larger airways warm up and humidify the air coming in. However, once you are respirating hard, and taking in more oxygen to meet demand, your lungs start utilizing smaller airways to help humidify the overflow.
Unfortunately, this is a tougher task for those small pathways and they are more easily dehydrated and irritated in the process. There isn’t enough humidity to go around and all that dry air can cause spasms.
On a cellular level, your lungs are affected by the loss of hydration as they try to humidify all the air. When there is a loss of cellular volume, all kinds of things can happen. Your body can have an inflammation response, or release cytokines or histamine, all of which can make it harder to breathe during exercise.
Also, there are strong links to EIB in swimmers, and outdoor athletes, especially cold-weather endurance athletes. The evidence points towards cold air, pollutants, and chemicals that repeatedly irritate and damage the lungs, eventually causing asthma-like problems.
Another cardiovascular issue that affects elite endurance athletes is the inability to take in oxygen efficiently and flush out CO2. At a point, certain athletes hit a glass ceiling of oxygen efficiency. They cannot meet the demand as effectively. It is called exercise-induced arterial hypoxemia (EIAH.)
Some theories suggest it is caused by inefficient exhalation, but there is also a possible cause with an inability to uptake the oxygen due to excess fluid in the lungs and capillary blood volume changes.
If the hypoxemia is prolonged, the athlete may feel breathless, start to cough, and feel hazy or unfocused. This is not something that usually happens to the casual exercise enthusiast. The endurance levels required for this type of inefficiency are pretty high. It is not EIB in of itself, but it can be another reason for lung problems in athletes.
Performance Enhancing Drugs
There is one part of the story with elite athletes that many of us gloss over and that is the use and abuse of performance-enhancing drugs. My boss was on cycles of clenbuterol during is hardcore days. “Clen” is used to dilate the airways and uptake more oxygen for cardiovascular sports.
It is also used in bodybuilding circles as a stimulant and a steroid. His doctor believes part of his current lung malfunction is due to cycles of clen, on top of grueling, non-stop, cardiovascular sessions.
There are plenty of athletes who take these kinds of drugs. They may stimulate the lungs or the heart or flood your body with more red blood cells. The goal is the same – increased cardiovascular efficiency and effectiveness. All of that overstimulation and the increased ability to train longer and harder (read: breathing harder and longer, increasing your risk of lung injury,) might be doing serious, long-term damage.
How Can We Thrive With EIB?
The good news is EIB should not slow you down. One of the worst things you can do if you have exercise-induced bronchoconstriction is to stop exercising. Not only does that weaken your cardiovascular system, but low-activity levels correlate to weight gain. The more weight you are carrying, the more frequent and severe your symptoms will be.
Chances are, you are not an elite endurance athlete. Hopefully, you are not taking any banned substances to get ahead. Although you may feel at times that you are “overtraining,” you are probably just fine. The best thing to do is stay fit and use your inhaler before a particularly tough workout.
Other steps you can take are:
Exercise in a warm environment. Cold air seems to aggravate the bronchial passages, so limit the outdoor winter runs and try to keep warm.
Hydrate. Dryness is another irritant. Make sure your environment has some humidity and your body does as well.
Warm-up beforehand. It is easier on the lungs to ease into a workout than to dive in at 60 miles-per-hour. Try not to overstimulate your respiratory tract right off the bat.
Vary your workouts. Not every workout has to be a marathon. Try lifting weights and doing shorter bursts of cardio as well. Those activities are very healthy and will cause less of a reaction.
Do not let EIB hold you back. This is not a severe diagnosis, but it can be uncomfortable at times. Get tested, use your inhaler and go for it! If the world’s top athletes can train for the Olympics with asthma, and go on to medal, you can go for a run. In fact, this condition can get far worse if you don’t.
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