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Exercise-Induced Bronchospasm

What Is Exercise-Induced Bronchospasm (EIB)?

EIB is a disorder that causes breathing problems during or after exercise. The exact cause of EIB is unknown. One theory is that rapid breathing during exercise causes the air tubes (airways) to dry out. When the airways dry out, they become irritated, which can cause the air tubes to tighten and get smaller (bronchoconstriction). Small air tubes make breathing harder. Another theory is that EIB is caused by bronchitis: injury to the layer of cells that line the airways caused by high flows of air moving through those airways during exercise. Research is ongoing to investigate these theories and to better define why EIB develops.


Who Gets EIB?

EIB can occur in people with and without asthma. About 80% of people with asthma will have EIB. About 5-10% of the general population without asthma will have EIB. Athletes have a much higher rate of EIB. In studies of Olympic and other elite athletes, EIB occurred in 20-50% of athletes without asthma. Many of these athletes did not even know they had EIB. People with allergies, sinus problems, or a family history of allergies are more at risk for EIB.


What are the Symptoms of EIB

Breathing symptoms can range from mild to severe and can start during or shortly after exercise. The most common symptoms are:


How Is EIB Diagnosed?

A health care provider will ask about your breathing, do a physical exam, and order lung function tests. A Eucapnic Voluntary Hyperventilation (EVH) test is one of several tests used to diagnose EIB. It is performed by breathing a mixture of dry air (oxygen/carbon dioxide) very fast into a breathing machine that measures the air going into and out of the lungs. General lung function is measured before the test and at several points after the test to see if there is any change. If someone has EIB, his or her lung function will drop for a short time during or after the test.


How Is EIB Treated?

EIB can be treated effectively in the majority of cases. The best treatment for EIB is to use an inhaled medicine that opens the airways 15-20 minutes before exercise. These medicines quickly open the air tubes and keep them open for up to 4 hours. The most common “pre-treatment” medicines include Proventil ® (albuterol), Ventolin ® (albuterol), or Maxair ® (pirbuterol). Using a pre-treatment medicine usually prevents EIB. If pre-treatment medicine does not work or if breathing problems get worse, consult with your health care provider.


What Else Can I Do?

A brief warm-up (break a sweat) for 5-10 minutes before exercise may also help prevent EIB. You should rest for 5 minutes after the warm-up.

If the air is cool and dry:

  1. Exercise indoors.
  2. Breathe through your nose during light exercise.  The nose warms and adds moisture to the air more than mouth-breathing.
  3. Wear a scarf or mask over your nose and mouth to warm the air before it goes into the lungs.

If air pollution (ozone alert) or pollen counts are high:

  1. Exercise indoors.
  2. Talk to your health care provider about allergy symptoms (nose congestion, sneezing, or itchy eyes).


What Exercise Is Best?

EIB should not prevent you from reaching your exercise goals.  You can do any activity with the proper training and medicine.

Many elite athletes have excelled with proper treatment of their asthma/EIB:

  • Jerome Bettis, NFL football player
  • Tom Dolan, Olympic medalist – swimming
  • Jackie Joyner-Kersee, Olympic medalist – track and field
  • Bill Koch, Olympic medalist – cross-country skiing
  • Greg Louganis, Olympic medalist – diving
  • Art Monk, NFL football player
  • Hakeem Olajuwon, NBA basketball player
  • Paula Radcliffe, Olympic long distance runner
  • Dennis Rodman, NBA basketball player
  • Caitlin Sanders, Olympic medalist – swimming
  • Dominique Wilkins, NBA basketball player
  • Joanna Zeiger, Olympic triathlete

For more information:

Go to the Asthma health topic.