Do you wheeze during a workout? Do you cough after a morning jog? If so, don't despair. You could be Olympic material.

Many athletes at all levels, including about 20 percent of U.S. Olympic athletes, have asthma. Even though exercise can trigger an attack, people with asthma don't have to stay on the sidelines. With the right treatment, practically anyone with asthma can compete in any sport -- even at the highest levels.

Exercise: A powerful trigger

Of course, you need to take some precautions when you exercise. When a person has asthma, the bronchial passages (tubes that carry air to the lungs) become exceedingly sensitive to their surroundings. Just about anything out of the ordinary -- a little dust, a blast of cold air, a puff of smoke -- can make the tubes suddenly squeeze tight, leaving little room for air to pass through. This is called an asthma attack.

Surprisingly, a good workout can be one of the surest ways to trigger an attack. Just six to eight minutes of strenuous exercise can be enough to cause coughing, wheezing, shortness of breath, and tightness in the chest. In fact, many people have "exercise-induced asthma," which means they have asthma only when they exercise. Even patients with persistent asthma may notice breathing problems primarily when they work out.

Exercise is supposed to be good for the lungs, so why does it leave so many people wheezing? When we work out, our airways lose both heat and moisture, especially if the air is cold and dry. One of those losses -- or both -- seems to help inflame the bronchial tubes and set the stage for an attack. That explains why a winter jog around the neighborhood is more likely than a run in a warm gym to cause an attack.

Who's most at risk?

Some sports seem tailor-made to set off asthma attacks. Take, for instance, cross-country skiing, ice skating, and ice hockey, all vigorous sports performed in the cold. One study found that 55 percent of elite cross-country skiers and 35 percent of figure skaters showed signs of asthma.

Asthma attacks are also common in sports that require intense, continuous effort, such as long-distance running, soccer, and cycling. On the other hand, stop-and-go activities such as baseball, sprinting, and golf rarely cause trouble. Swimming and water polo don't bring on many attacks, either, probably because pools are so humid.

Staying in the game

No matter what your sport, asthma doesn't have to slow you down. If you wheeze, cough, or feel tightness in the chest during or after exercise, talk to your doctor. Several prescription medications can prevent exercise-related asthma attacks and keep you in the game.

For many people, the best defense is an inhaler filled with a quick-acting beta agonist bronchodilator such as albuterol or pirbuterol. Taken 15 minutes before exercising, it relaxes the muscles around your airway and helps to keep you breathing freely for up to four hours. If the attacks continue, your doctor may prescribe additional inhaled medications such as cromolyn or nedocromil. If your workouts are extremely long, you might try a long-acting beta agonist bronchodilator -- such as salmeterol -- which can ward off attacks for up to 12 hours. However, the latest government guidelines caution that drugs like salmeterol shouldn't be used alone for long-term asthma control. And if you are African American, you should talk to your doctor about other possible treatment options. A recent study found that salmeterol caused significantly higher incidences of asthma-related events in African Americans, prompting the FDA to issue a safety warning followed by its strongest caution, a "black box" warning.

Whatever medication you may take beforehand, keep an inhaler handy while you exercise. (Keep it within easy reach at all times -- not in the glove compartment of your car.) If you have an attack, a couple puffs of albuterol or a similar medicine can open your airways and restore your breathing capacity.

You may also want to pack a peak-flow meter in your gym bag. This small, handheld device measures the force of your breath. When asthma grips your airways, the reading will drop. If you have a low reading before or during a workout, you'll need extra medication or an exercise break.

A few simple changes in your exercise routine can also help prevent attacks. Before exercising, try warming up by walking, stretching, and briefly running in place. When the workout's over, a little more walking and stretching can help keep your airways from tightening up. If possible, avoid exercising in places with a lot of dust, pollen, animal dander, or air pollutants. Your lungs don't need any extra irritation. And if you're exercising in the cold, wear a scarf or a mask around your mouth and nose area.

Above all, stay active. Asthma or no asthma, exercise is the best health tonic around. You'll feel like a winner -- even if you never make it to the medal stand.

Further Resources

American Academy of Allergy, Asthma, and Immunology 800-822-ASMA http://www.aaaai.org

American College of Allergy, Asthma, and Immunology 800-842-7777 http://www.acaai.org

American Lung Association 800-LUNG USA http://www.lungusa.org

Asthma and Allergy Foundation of America 800-7-ASTHMA http://www.aafa.org

References

Asthma and Exercise. n.d.) AAAI. http://www.aaaai.org/conditions-and-treatments/library/asthma-library/asthma-and-exercise

Weiler JM, Ryan EJ 3rd. Asthma in United States Olympic athletes who participated in the 1998 Olympic winter games. : J Allergy Clin Immunol;106(2):267-71

National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

American Lung Association Family Guide to Asthma and Allergies. Chapter 15: The Benefits of Exercise. Little, Brown & Co.

Fact sheet from the American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/patients/gallery/

American Academy of Allergy, Asthma, and Immunology. August 2004: Winning with Exercise-Induced Asthma. http://www.aaaai.org/patients/topicofthemonth/0804/

U.S. Food and Drug Administration. 2003 Safety Alert--Serevent (salmeterol xinafoate). http://www.fda.gov/medwatch/SAFETY/2003/serevent.htm

Food and Drug Administration. FDA Public Health Advisory: Serevent Diskus (salmeterol xinafoate inhalation powder), Advair Diskus (fluticasone propionate & salmeterol inhalation powder), Foradil Aerolizer (formoterol fumarate inhalation powder). http://www.fda.gov/cder/drug/advisory/LABA.htm