Exercise-Induced Bronchoconstriction (EIB) | ACAAI Public Website (2024)

Symptoms

EIB is caused by the loss of heat, water or both from the airways during exercise when quickly breathing in air that is drier than what is already in the body. Symptoms typically appear within a few minutes after you start exercising and may continue for 10 to 15 minutes after you finish your workout. Anyone can experience these symptoms (especially someone who is out of shape), but with EIB, they are more severe. Wheezing in children after physical activity is often the first symptom of asthma.

Common symptoms of EIB include:

  • Shortness of breath or wheezing
  • Decreased endurance
  • Tightness in the chest
  • Cough
  • Upset stomach
  • Sore throat

EIB triggers include airborne irritants related to specific sports. Examples are:

  • Chorine when swimming
  • Pollution while running or cycling
  • Cold, dry air while ice skating or playing hockey
  • Air temperature during hot yoga.

When you are working out or competing in a gym, perfume, cleaners, paint, and new equipment or carpet could also be triggers.

While it was thought for years that breathing cold air makes EIB worse, more recent studies indicate that the dryness of the air, rather than the temperature, is more likely the trigger. Cold air typically contains less moisture than warm air, and quickly breathing dry air dehydrates the bronchial tubes, causing them to narrow and restrict airflow.

The sports and activities that are most likely to cause EIB symptoms require constant activity or are done in cold weather. These include soccer, basketball, long-distance running, ice hockey, ice skating and cross-country skiing.

The activities that are least likely to cause EIB symptoms include walking, hiking and recreational biking, or sports requiring only short bursts of activity. These include volleyball, gymnastics, baseball, wrestling, golf, swimming, football, and short-distance track and field sports. Some swimming events can demand constant activity, but the warmth and humidity from the water make it easier for people with EIB to breathe.

Diagnosis

Do you have EIB? Sometimes this can be difficult for athletes to know. Everyone has had trouble completing a workout at times, and athletes don’t often think of EIB or asthma as the cause.An allergistcan determine whether your symptoms are exercise-induced alone, are a reaction toallergensor irritants in the air, or are an indication of underlying asthma.

As part of an examination, your allergist will take a history (including asking for information about any relatives with asthma or other breathing difficulties). You also may be asked for specific details about your physical activity, including where and how often you exercise. Your allergist will also consider other conditions, such as upper-airway problems, that might play a role in your difficulties with exercise.

To check how exercise affects your breathing, your allergist may measure your breathing before, during and after you run on a treadmill or ride an exercise bike. During the test you will breathe into a tube that connects to a spirometer, a device that measures the volume of air being inhaled and exhaled.

In some cases, environmental factors may contribute to EIB. Skaters and hockey players can be affected by a combination of cold, dry air in ice rinks and pollutants from ice-resurfacing machines. EIB in distance runners has been linked to exercising in high-allergen and high-ozone environments. In addition, indoor air with high levels of trichloramine, a chemical used in pool chlorination, has been linked to asthma and EIB in swimmers.

Treatment and Management

Two types ofmedicinesused to treat asthma are also used to prevent and treat EIB symptoms. They are usually taken through an inhaler, though some are available in tablet form:

  • Short-acting inhaled beta2-agonists (bronchodilators) stop symptoms right away. They may be taken 15 to 30 minutes before vigorous exercise and generally prevent symptoms for two to four hours. These medications are extremely effective in treating or preventing EIB symptoms, so if symptoms do not improve, let your allergist know.
  • Long-term control asthma medicines are taken daily to prevent symptoms and attacks.
  • Inhaled corticosteroids. These are the most commonly prescribed long-term asthma medications. They help to relieve narrowing and inflammation of the bronchial tubes. It may take two to four weeks before these drugs reach their maximum effect.
  • Long-acting inhaled beta2-agonists (bronchodilators). Taken 30 to 60 minutes before exercise, these medications help prevent symptoms for 10 to 12 hours. They should be used only once within a 12-hour period, and they should be taken only in combination with an inhaled corticosteroid.
  • Montelukast, a leukotriene receptor inhibitor, is also approved for the treatment of exercise-induced asthma symptoms. Taken once daily, this medication can help prevent symptoms that accompany exercise.

Elite athletes should check with the governing bodies of their sport about the medicines they are allowed to take to relieve their EIB or asthma symptoms. Another resource is the Prohibited List, published by the World Anti-Doping Agency. Some medications (including beta2-agonists) are considered performance-enhancing drugs and cannot be used by athletes in competition unless a Therapeutic Use Exemption is granted for medical need. Your allergist can help you answer questions about your medications.

Other suggestions for relieving symptoms of EIB include:

  • Warm up with gentle exercises for about 15 minutes before you start more intense physical activity.
  • Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.
  • Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.
  • Avoid triggers by making changes to your exercise routine.
  • See an allergist to discuss prescription medications, which may be more effective than over-the-counter treatments.

If you continue to experience symptoms when you exercise, talk toyour allergist. Together, you can work to adjust yourpersonal treatment planto make sure you’re feeling and performing your best.

Exercise-Induced Bronchoconstriction (EIB) | ACAAI Public Website (2024)

FAQs

Exercise-Induced Bronchoconstriction (EIB) | ACAAI Public Website? ›

Overview. Exercise-induced bronchoconstriction

bronchoconstriction
Bronchoconstriction is defined as the narrowing of the airways in the lungs (bronchi and bronchioles). Air flow in air passages can get restricted in three ways: a spasmodic state of the smooth muscles in bronchi and bronchioles. an inflammation in the middle layers of the bronchi and bronchioles.
https://en.wikipedia.org › wiki › Bronchoconstriction
, or EIB, is the preferred term for what was known for years as exercise-induced asthma . Symptoms develop when airways narrow as a result of physical activity. As many as 90 percent of people with asthma also have EIB, but not everyone with EIB has asthma.

How do I know if I have EIB? ›

You may have EIB if any of these occur after 5 to 10 minutes of exercise: You start to cough. Your chests feel tight, or you feel chest pain. You have trouble breathing.

How do you get tested for EIB? ›

Methacholine challenge breathing test

This test involves inhaling an agent, often methacholine, that narrows the airways in some people with exercise-induced bronchoconstriction. Afterward, a spirometry test checks lung function.

How long does it take to recover from EIB? ›

Symptoms usually resolve spontaneously within 30 to 90 minutes and induce a refractory period of 1 to 3 hours, where continued exercise does not produce bronchoconstriction. [1] Patients may also be asymptomatic, and therefore EIB may be underdiagnosed.

What does exercise-induced bronchoconstriction feel like? ›

It causes shortness of breath, wheezing, coughing, and other symptoms during or after exercise. The medical term for this condition is exercise-induced bronchoconstriction (brong-koh-kun-STRIK-shun). Many people with asthma have exercise-induced bronchoconstriction. But people without asthma also can have it.

What conditions mimic EIB? ›

Co-existing conditions, or conditions that may mimic EIB, include asthma, upper-airway cough syndrome, chronic eosinophilic bronchitis, allergies, rhinitis, gastroesophageal reflux (GERD), exercise induced laryngeal obstruction (EILO), central airway obstruction, exercise-induced anaphylaxis, restrictive lung disease, ...

How do you get rid of exercise induced bronchospasm EIB? ›

Treatment and Management. Two types of medicines used to treat asthma are also used to prevent and treat EIB symptoms. They are usually taken through an inhaler, though some are available in tablet form: Short-acting inhaled beta2-agonists (bronchodilators) stop symptoms right away.

Can you have EIB without asthma? ›

EIB can occur in both patients with and without asthma, with the prevalence in patients with asthma estimated at approximately 90%.

What triggers EIB? ›

The dry and/or cold air is the main asthma trigger for airway narrowing (bronchoconstriction) and inflammation seen in EIB. Exercise that exposes you to cold, dry air is more likely to cause asthma symptoms than exercise involving warm and humid air.

What medication is used for EIB? ›

Patients with EIB alone are usually recommended an inhaled short-acting beta2-agonist (SABA) to be used 5 to 20 minutes before beginning exercise. However, if these patients end up requiring a SABA daily, it would be more effective to add a controller medication such as an inhaled corticosteroid (ICS).

What is the best medication for exercise-induced asthma? ›

Mild attacks – Take your rescue medication: most people take two puffs of albuterol or levalbuterol, or one puff of formoterol-budesonide. This may be repeated twenty minutes later, and then periodically (every two to four hours) until symptoms are improved.

Do I have asthma or EIB? ›

For people with asthma, symptoms tend to get worse when they are around other triggers, such as allergens. In people with EIB, symptoms continue for 10–15 minutes after a workout ends. EIB can cause coughing and wheezing. People with EIB may experience nausea, which is uncommon in those who are just out of shape.

What are the risk factors for EIB? ›

Risk Factors and Triggers

Oral breathing does not warm the air, thus making it more likely to provoke airway cooling and EIB. Allergens, high pollen counts, pollution, and dry air can trigger symptoms.

How do I know if I have exercise-induced asthma? ›

Someone with EIA may: have wheezing , tightness or pain in the chest, coughing, or shortness of breath during or after exercise. get winded or tired easily during or after exercise. cough after coming inside from being active outdoors.

What does bronchospasm feel like? ›

The signs of bronchospasm are fairly apparent while the severity of symptoms is directly related to how much the airways have narrowed, or how much airflow has been restricted. Common symptoms of bronchospasm include: pain, tightness, and a feeling of constriction in the chest and back.

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