Breathe Better: Understanding Exercise-Induced Asthma

Asthma, including exercise-induced asthma (EIA), is the diagnosis given to more and more people everyday, from kids to overfat individuals and yes, even to the very fit athlete. This condition is defined as a spasm or constriction of the bronchials causing diminished airflow resulting in wheezing, tightness of the chest, difficulty breathing, and sometimes coughing. When the vital capacity, or the total volume of air that can be forcibly exhaled in one breath, does not change or decreases with exercise, the person most likely has EIA. The vital capacity should normally increase with exercise. Almost all people with asthma will have EIA, but those with EIA do not necessarily have a problem with breathing unless exercising. EIA is very common in runners, swimmers, cyclists, and triathletes, and it is definitely not normal. It’s a clear sign your health is suffering and has been for some time, and now your fitness is too.

Athletes of all ages are given the diagnosis of EIA as they suddenly develop these breathing difficulties that appear out of nowhere. (“Just started one day while I was running.” or “I never had this problem before but I couldn’t catch my breath during the race.”) These symptoms are thought to have no specific origin. There are numerous prescribed anti-asthma medications on the market today, and EIA is commonly diagnosed and treated with prescription drugs with no attempt to understand the underlying processes which cause the problem. This article will shine some light on the matter.

There are currently six different categories of anti-asthma medications. Which individual drug may help a given patient depends on what is causing the asthma symptoms. The medication isn’t going to cure the asthma, it will simply help the person manage it better. One of the clues used to help an individual truly overcome the cause of their asthma is to see what medication benefits them most. Whether they are not on a medication yet or not, then it’s important to fully investigate the origin of the asthma, so it may be dealt with at the source.

Although asthma is a symptom of the lungs, there is most always not a primary lung problem to be dealt with, but a problem from another area of the body affecting the function of the lungs. Likewise, the medications used to combat asthma have been developed to treat the areas of the body that are thought to cause the constriction-spasm symptoms of the bronchials.

So what is causing the asthma and how do you go about fixing it, or at least dealing with it to the best of your ability? The answer depends on what is triggering your asthma. What is causing your asthma can be completely different from what is causing your friend’s asthma, even though your symptoms appear to be identical.

The majority of asthma medications developed are made to enhance adrenal gland function and are called Beta2-adrenergic agonists. The usual medications in this category are albuterol (Proventil, Ventolin) and Epinephrine (an adrenal gland derived hormone), though there are many more such as levalbuterol, terbutaline, Maxair, and Foradil. When the adrenal glands are under a lot of stress, whether from training too hard or too often, emotional stress, nutritional stress (too much refined sugar, caffeine, alcohol, poor diet), or a combination of these, then the adrenal glands slowly become depleted over time. The adrenal glands are responsible for many important functions in your body. They help with your electrolyte balance; they help manage hormone levels; they determine how you manage your glucose and energy levels; they influence how you repair your joints and fight inflammation; they affect your mood and even your sleep. The big idea here is that if one important organ isn’t working as well as it should, you can have many symptoms going on. You can drive yourself crazy going from one doctor to the next trying to understand and fix each problem separately, but many times they are all closely related. That is why an athlete may not be sleeping well, not being able to get over an injury, and having a problem managing electrolyte imbalances while training or racing, all as a result of one process not working as well as it should. Asthma can easily enter the picture here. This explains why suddenly having asthma symptoms one day while heading out for a run is really an end process of a longer period of depleting your reserves. The stress has caught up with you and to deal with it effectively and get over it, you need to understand why it is there and where it is coming from.

Other times, the asthma is a result of the adrenal glands, but from a different part of the gland, the adrenal cortex. These are corticosteroid medications. This type of asthma can be influenced by insulin insensitivity and carbohydrate intolerance. The medications used to help deal with the asthma are those such as Flovent, Pulmicort, Qvar, and Aerobid. Treating this asthma at the source involves investigating the adrenal glands, the pancreas, the diet and exercise (or lack of) habits, and lifestyle stressors of the individual.

Medications like Advair and Symbicort combine both the corticosteroid activity and the Beta2 drugs noted above.

When an athlete is helped by Ipratropium, (Atrovent, Apovent, Aerovent), an anticholinergic medication, there is a problem with the balance between the sympathetic and parasympathetic nervous system. This is many times associated with an adrenal or stress pattern affecting the neurtransmitter acetylcholine in the body that has gone on for some time and the body is having trouble recovering.

Not always is asthma a result of adrenal gland depletion. In the case where the asthma is triggered by histamine, an allergic reaction must be sought as the culprit. Antihistamine/allergy medications such as Omalizumab (Xolair), Intal (cromolyn) and Tilade will show a beneficial effect, but to get to the bottom of this type of asthma, the reactive chemical or allergy must be identified and treated. Many times this is a reaction to a food that was eaten two to three hours before exercise, but the reaction could be from ingesting the offending food over a period of time long before the exercise. Eliminating the food (or sometimes chemical sensitivity) from the diet and helping the individual’s immune system overcome the stress can result in dramatic changes is health and performance. This type of reaction is very, very common (along with the adrenal gland issues). You can read more about allergies on my other site, by clicking here.

Then there are those in the smaller categories that have asthma as a direct result to the lungs in which case something is triggering the lungs directly. This could be from a chemical or environmental sensitivity/allergy (sulfite, strong perfume, pollen/grasses). Aerolate is one example this xanthine bronchodilator medication used conventionally to help this reaction.

Medications known as a leukotriene modifiers (Accolate, Singulair,Zyflo) are also common. They’re used to combat inflammatory conditions that are much stronger than those resulting from an immune-histamine reaction. They also come with psychological side effects such as aggression and depression. Fighting this type of inflammation as well as most inflammation in your body involves balancing fatty acid metabolism (Omega 3 & 6 fats), dealing with insulin resistance/carbohydrate intolerance, and assessing antioxidant status.

Whether you have asthma or EIA it is important to know what is triggering your asthma and how to treat it effectively. Sometimes it is easy to help an athlete get over their asthma by treating the underlying processes which cause it, especially if they just started having symptoms. Other times, a more thorough investigation is needed to understand what is at the base of the problem. But whatever the case, as the asthma cases are skyrocketing, you now have an understanding of how you might get your second wind.

Dr. Stephen Gangemi "Sock Doc"

I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.