Exercise induced asthma (EIA) is a condition of respiratory difficulty because of brochoconstriction related to histamine release. The signs and symptoms of EIA resemble that of an allergic asthma but may be vague and unrecognizable and are usually triggered by aerobic exercise or physical activity. The symptoms become more apparent with exercise and physical activities and are known to be due to a number of factors which include medical condition, environmental factors and medications. Generally, EIA is diagnosed clinically and may not need any further laboratories and imaging studies. The optimal treatment of EIA is to prevent the onset of symptoms while controlling the underlying condition. It is also imperative that the treatment is complemented by a combination of drugs that prevent the inducement of the symptoms of exercise induced asthma. With proper interventions, the prognosis of this condition is excellent.
What are the symptoms of EIA?
The clinical presentation of EIA usually presents as chest tightness or chest pain, cough, shortness of breath, wheezing, poor performance of an athlete during a field play, fatigue, prolonged recovery time and gastrointestinal discomfort. There are also factors that may affect the symptoms which include cool temperature, low humidity, poor physical conditioning and coincident respiratory tract infection. Individuals who have such symptoms usually deny them because of peer pressure, embarrassment, fear of losing a position in the team and misinterpretation of post exercise fatigue. However, concealing the symptoms will prevent the early diagnosis of the condition which once left untreated may progress to more complicated health issues.
The inducement of exercise related asthma
There are three categories of causes that are known to induce the symptoms of asthma during exercise. These include medical conditions, environmental and drug related causes. Poorly controlled asthma increases symptoms with exercise. Poorly controlled rhinitis, especially those with thick secretions, as well as those with respiratory tract infections aggravate both asthma and EIA. Excess pollens and pollution also exacerbate allergy induced EIA. Chemicals such as insecticides, pesticides and fertilizers to maintain the playing field as well as chlorine in pools may exacerbate wheezing and can also worsen the EIA symptoms. Certain medications like beta blockers, aspirin, NSAIDS and diuretics also provoke the symptoms of EIA.
How an exercise induced asthma diagnosed?
Exercise induced asthma is generally diagnosed clinically. However, laboratory evaluation is also done for equivocal cases, treatment failure and to narrow differential diagnosis. Challenge testing is also done to formalize the diagnosis. This includes treadmill exercise, informal exercise challenge, pulmonary function testing, brochoprovocation testing, and eucapnic voluntary provocation. Imaging studies such as chest radiography, lateral neck radiography or soft tissue penetration and echocardiography may also be included in the work up. Post exercise laryngoscopy may also be used to assess vocal cord dysfunction which is often mistaken as an exercise induced asthma.
The proper management for EIA
The optimal treatment for EIA is to prevent its symptomatic onset. Underlying conditions that affect and aggravate the symptoms should also be treated first. Pharmacotherapy of exercise induces asthma is pre-exercise short acting beta 2 agonists. Other medications include leukotriene receptor antagonists, long acting beta 2 agonists, xanthine derivatives, mast cell stabilizers, inhaled corticosteroids, and adrenergic agents. Part of the management is the administration of non-pharmacologic measures that include sports selection, altering breathing techniques such as changing from predominant mouth breathing to nasal breathing resulting to less bronchospasm, and coordination and timing of competition and medications. In sports selection, the environments that less likely to cause bronchospasm should be considered. It should also be considered that the individual should choose sports with less prolonged aerobic demands for better tolerance to exercise and physical activities.
When you feel that the symptoms of an asthma is triggered by exercise, consult your doctor now in order to get the proper diagnosis.
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