Breath free: exercise-induced asthma can strike even the fittest man, and mild symptoms are easy to miss. Here's what to do if your lungs are holding you back

Men's Fitness, Sept, 2001 by Garrison Frost

Matt Wachtfogel remembers exactly when his lungs turned on him.

"I was about 20 and living in Lake Tahoe and skiing at Squaw Valley every day," he recalls. "It was near the end of the season and I decided to go running. I'd been going for about 10 minutes when my chest suddenly got tight and I started wheezing. It felt like someone was sitting on my chest."

For Jake Courtney, it began with a dry cough and shortness of breath. Unfortunately, he was running in the state finals at the time. "I suddenly couldn't breathe," he relates. "I stumbled to the finish line and my team lost by two points."

Wachtfogel and Courtney are describing the signs of exercise-induced asthma. It's a condition they share with about 12 million Americans, many of whom are otherwise healthy and physically fit. You can be laid low by EIA after a third set at the gym or in the midst of a world-class competition. In fact, a study conducted by the University of Iowa at the 1996 Olympics found that about 15 percent of the athletes suffered from asthma symptoms.

According to Robert Fick, M.D., a professor at the Stanford School of Medicine and president of the California Thoracic Society, the only difference between EIA and garden-variety asthma is that the trademark wheezing and coughing are triggered by physical exertion, not by allergies or particulates.

EIA can be defined as the sudden constriction of bronchial passages following five to 12 minutes of strenuous exercise. Researchers are divided over exactly what happens inside the body to trigger such bronchospasms. One theory is that rapid breathing during exercise dries out mucus in the lungs, making it thicker and stimulating a constricting nerve reflex. Another is that the inhalation of cold, dry air irritates inflammatory mast cells in the lungs, releasing chemicals that constrict airways.

"Regardless of the process, what is happening is that the airways are getting narrower," says Fick. "It's like breathing through a straw."

COLD-WEATHER WARNING

EIA usually manifests in the first phase of training, especially if you don't warm up prior to exertion. It's more easily provoked when the air is cold and dry. "It's particularly bad in the winter months," says Courtney. "On a warm summer day, I feel a decreased chance of having a bad time. But if I don't do a good warm-up by starting out slow--if I rush--I'll pay for it."

Like most medical conditions, EIA exists in both mild and extreme forms. Not everybody who suffers from EIA comes to a wheezing halt at the side of the road. Mike Miller, a trainer at El Camino College in the Los Angeles area, says that someone who suffers a sudden decrease in performance, performs inconsistently, or experiences energy loss after a workout may also have EIA.

"Because these people are in such good shape, there's a tendency to see it as something other than health-related," Miller says. "But there are subtle signs that you just can't dismiss. A good trainer should be able to spot that and conduct the right tests."

Most people who exercise can successfully manage the condition and continue to perform at peak levels. Warming up is one way to lower the risk of bronchospasm, as is working out in warmer weather or indoors. Those with mild symptoms have also had success simply pushing through the spasms, which usually peak within six to eight minutes and gradually cease after 30 to 60 minutes. Because it takes the inflammatory cells several hours to regain their ability to cause another spasm, someone who can ride out the storm will probably be able to complete his workout.

Some activities have been found to pose a greater risk of producing a bronchial reaction. These include distance running, basketball, soccer and cycling, as well as cold-weather sports such as cross-country skiing, ice hockey and ice-skating. Some low-risk options include football, baseball, sprinting, swimming and water polo.

TREATING BODY AND MIND

For those who require medication, the most common treatments are prescription inhalants such as cromylin sodium and albuterol. Wachtfogel has been using various forms of the latter to great success. He surfs, runs on the beach and plays volleyball. "It's kind of a pain to use the inhaler every time I want to exercise, but it's a lot better than the alternative," he says.

Courtney's treatment path has been rockier. A chronic asthmatic, he also suffers from allergies and sinus problems. After more than 20 years of trying out different combinations, he says he only recently arrived at a drug regimen that works. Although he still competes in distance events, he's had to battle the psychological impact of EIA as well.

"Before I had EIA symptoms, I was a run-from-the-front animal," he says. "Once I had EIA, I began to start slow. I always felt that I couldn't take it to that next level."

Miller's experience has taught him that an athlete isn't the same until he's confident that the risk of bronchospasms is behind him. "Someone with severe asthma may develop a fear that if he pushes the envelope, he'll get the symptoms," Miller says. "That can become a weakness."