Exercise Induced Asthma vs Out of Shape: Why Do you Wheeze After Running?

Why Sports-Induced Asthma May be Limiting Your Ability to Perform and Keep Fit, and How Breathing Exercises Can Help.

Do you cough, struggle to breathe and wheeze after running? It may not be because you are out of shape. Even elite professional athletes experience asthma-like breathing symptoms due to exercise-induced bronchoconstriction and spasm in the airways.

However, there are steps you can take to get back on track. Read on for symptoms, common causes, and research-supported breathing strategies that can help alongside your medical care.

What Is Exercise-Induced Asthma?

Exercise-induced asthma is a condition in which breathing symptoms occur during or after exercise. You might experience tightness and narrowing in your airways, nasal congestion, wheezing and coughing.

Although you may not have asthma when you are not exercising, the symptoms look and feel the same. Symptoms may occur as soon as you start exercising, or just after you finish. Some people report symptoms flaring up hours after their workout.

Asthma symptoms triggered by exercise are called exercise-induced asthma or exercise-induced bronchoconstriction (EIB). The word bronchoconstriction means that the bronchi, the airways leading into the lungs, have become constricted, or narrow. This is often triggered when the airways are cooled and dried by breathing large volumes of air.

The two terms are often used interchangeably, though EIB more accurately refers to acute airflow obstruction without broader asthma symptoms.

Do I Have Exercise-Induced Asthma?

Do you fatigue early during exercise? Do you need to stop and catch your breath? Do you experience wheezing or coughing after running, or feel like the air conditioning at your gym leaves you with burning lungs? These can be signs of exercise-induced asthma. Your doctor can confirm it with breathing tests.

Exercise-induced asthma is not choosy. It does not care who you are or how hard you train. A high proportion of top athletes experience sport-induced asthma, and it is more common in endurance sports and higher levels of competition. Symptoms tend to be more common in people who train the most.

This seems to contradict the advice that regular exercise can improve asthma control [1]. But very high training loads may leave the airways and immune system more vulnerable. If you train for many hours a week, breathing symptoms can affect your performance and your long-term health.

Is Exercise-Induced Asthma Common?

Yes. Around 90% of asthma sufferers get symptoms during or after physical exercise. About 10% of people who do not have asthma experience the symptoms of exercise-induced asthma. Among athletes, 15 to 25% have symptoms [2].

What Does Exercise-Induced Asthma Feel Like?

You may have some or all of these symptoms:

• Wheezing after running or working out
• Shortness of breath: you may feel like it is hard to get enough air because you cannot exhale fully
• Coughing after running or physical exercise
• Tightness or burning in your chest or lungs
• Excessive fatigue, getting tired sooner than normal, needing to stop frequently to catch your breath

Exercise-induced asthma can affect your quality of life and your ability to stay active. When you cannot breathe comfortably, exercise becomes challenging. Before long, you may find yourself reluctant to pull on your running shoes.

How Long Does Exercise-Induced Bronchoconstriction Last?

Symptoms will usually begin to fade after around 30 minutes of rest. Some people experience later symptoms in the hours after exercise, and it may take longer to recover.

What Causes Exercise-Induced Asthma?

There are many factors at play when it comes to sports-induced asthma, from immune responses and allergies to air quality and the size of your nose. One important factor that is often overlooked is how you breathe. This is empowering because it is something you can change.

Here are five reasons your airways may be reacting when you exercise.

1. You are breathing too much air

Normal resting breathing volume is around 5 to 8 litres per minute. Breathing increases during exercise as the demand for oxygen rises, and the more air you breathe, the more your airways are cooled and dried. Many people also over-breathe at rest and at easy intensities. Dysfunctional breathing tends to be fast, hard and through an open mouth.

Habitual mouth breathing can go hand in hand with nasal congestion, which makes it more difficult to breathe through the nose. Breathing large volumes of cold, dry air irritates the airway and can trigger swelling and airway narrowing. It is one reason you might notice discomfort in your nose or throat after exercise.

Several clinical trials have found that asthma symptoms, and the need for reliever medication, can reduce when people learn breathing techniques that reduce breathing volume. This suggests over-breathing can contribute to asthma symptoms [3,4,5].

A study at the Mater Hospital in Brisbane found that when adults with asthma learned the Buteyko breathing technique, their resting breathing volume fell from around 14 litres to 9.6 litres per minute. Their use of reliever medication fell substantially, by around 90% in the median, with a trend toward lower preventer steroid use and improved quality of life [3].

The control group, who were taught the hospital's in-house asthma-management program, showed much smaller changes.

Further trials have found that people with asthma who practice reduced breathing techniques can achieve better asthma control and, in some studies, reduce their preventer medication over three to six months under medical supervision [4,5].

2. You breathe through your mouth during exercise, rest, and sleep

The first step in addressing chronic over-breathing is to make the switch from mouth to nose breathing. Nasal breathing is important for everyone. But if you are prone to exercise-induced asthma, it is especially valuable.

When your breathing volume is greater than normal, you are likely to open your mouth to get more air into the lungs. This is especially true if you have an asthma diagnosis, as you may often feel like you cannot get enough air through your nose [6,7]. A paper published in the medical journal Chest noted that "asthmatics may have an increased tendency to switch to oral (mouth) breathing, a factor that may contribute to the pathogenesis of their asthma."

Scientists have found enforced mouth breathing reduces lung function in people with mild asthma [8].

Researchers studied the effects of nasal and oral breathing on exercise-induced asthma. Fifteen people were asked to breathe only through their nose. The study found that "the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral (mouth) breathing during exercise, indicating a beneficial effect of nasal breathing" [9].

Whether you have chronic asthma or not, mouth breathing during exercise makes exercise-induced asthma more likely. Breathing through an open mouth also leaves you more exposed to inhaled allergens and pollution, a particular issue for cyclists and runners, regardless of fitness level.

Mouth breathing influences sports-induced asthma in several ways:

• It leaves your airways unprotected from cold, dry air, and airborne viruses, bacteria, allergens, and other particles [10]
• It makes it easier to breathe a greater volume of air than you need, which can lower carbon dioxide. CO2 helps relax the smooth muscle in the airways, so low CO2 may contribute to airway narrowing
• Unlike nose breathing, mouth breathing does not give you the benefit of nasal nitric oxide, which supports immune defence [11,12,13]

In a paper published in the American Review of Respiratory Disease, the authors found that mouth breathing during exercise caused the airways to narrow further. In contrast, when subjects breathed only through their nose during moderate exercise, exercise-induced bronchoconstriction was almost completely prevented [14].

By breathing through your nose during suitable intensities, many people can reduce exercise-induced asthma symptoms [9].

3. You have been given bad breathing advice

Many sports coaches teach the practice of breathing in through the nose and out through the mouth. This is not ideal. In one study where people breathed cold, dry air, this pattern caused a 200% increase in nasal resistance that took around ten minutes to settle.

A blocked nose means you default to mouth breathing, and mouth breathing can aggravate your asthma. Exhaling through your mouth also increases water loss from the airways, which can trigger airway irritation.

4. You are breathing cold, dry air straight into your lungs

Whether you exercise outdoors or in the gym, you will likely encounter cold and dry air at least some of the time. When you breathe through your nose, air arrives in your airways warmed and moistened. If you breathe hard through an open mouth, you take in cold, dry air. This dehydrates and irritates the airway and can cause asthma symptoms or exercise-induced bronchoconstriction.

Cold air has a bigger effect when you breathe a large volume. As airflow increases, so too does the cooling effect of inhaled air. A study from researchers in Italy links high breathing volumes with greater airway cooling [15]. At 15 litres per minute, the temperature in the trachea dropped to 34 degrees C. At 100 litres it dropped to 31 degrees C.

Exercise-induced asthma is common in people who take part in winter sports. Studies have found a high percentage of skiers suffer with allergic rhinitis [16], and people with rhinitis often exhibit bronchial hyperresponsiveness, which is a risk factor for asthma.

5. You spend too much time in a chlorinated atmosphere

Swimming generally causes much less exercise-induced asthma than running or cycling. Many people with asthma favour swimming for this reason. The air in an indoor swimming pool is humid and warm. The pressure of water on the chest helps with exhalation. And the controlled breathing pattern of swimming tends to raise carbon dioxide, which may help relax the airways.

It is much easier to over-breathe on dry land, as breathing is not restricted in the same way it is in the water. When you swim, breathing is naturally constrained, which may help explain why swimming is often better tolerated by people with asthma [17].

In the words of respiratory consultant Dr. Peter Donnelly, writing in The Lancet: "In most land-based forms of exercise, patterns of breathing are not constrained, ventilation increases proportionately throughout exercise and end tidal CO2 tensions are either normal or low.

Therefore, there is no hypercapnic (increased carbon dioxide) stimulus for bronchodilation (airway opening) and asthmatics have no protection."

One study shows that narrowing of the airways affected 55% of football athletes and 50% of basketball players, but 0% of water polo athletes [18]. Water polo training involves breath holding and swimming underwater, and the warm, humid pool air and constrained breathing pattern may help explain the difference.

However, too much time in chlorinated pools can damage lung tissue, particularly for people with asthma [19,20,21,22]. Many swimmers also practice controlled breathing in the water but have dysfunctional everyday breathing patterns as soon as they step out of the pool.

Breathing Strategies to Help Exercise-Induced Asthma

Whether your goal is to improve performance or start exercising for better health, there are things you can do alongside your medical treatment to help manage symptoms of exercise-induced bronchoconstriction.

Since asthma is a condition that affects breathing, it makes sense to look at breathing too. Asthma often exists alongside dysfunctional breathing patterns. It can flare up when you over-breathe or breathe through an open mouth. Clinical trials have shown that breathing exercises can help reduce asthma symptoms and reliever use. If you have an asthma attack, use your reliever medication and seek medical help if it does not settle.

Here is what you can do to help reduce symptoms:

• Restore nasal breathing at rest and during sleep, and during exercise at suitable intensities. This means learning to breathe through your nose during exercise when the intensity allows.
• If your asthma symptoms are worse when you are running, train yourself to keep your mouth closed during warm-ups and easier sessions. If the air hunger is too strong, slow down until your breathing feels comfortable. Many people find they gradually build back up to their previous pace.
• If your asthma is well controlled, practice a few gentle breath holds after exhalation during your warm-up. Many people find gentle breath holds help their nose feel clearer and their breathing calmer. Avoid strong breath holds if your asthma is severe or uncontrolled.
• Practice breathing exercises to reduce your breathing volume at rest. When everyday breathing is calmer and lighter, your airways are exposed to less unnecessary drying and irritation.
• Track your BOLT score as a personal baseline, and aim to improve it over time. BOLT measures how quickly you feel the first clear urge to breathe during a comfortable breath hold. Many people find their breathing symptoms ease as their BOLT improves, but BOLT is not a measure of asthma control.
• If you regularly wake with a dry mouth, or snore loudly, lip taping during sleep can help support nasal breathing, as long as you can breathe comfortably through your nose. You can use a medical paper tape or MyoTape, Patrick McKeown's patented mouth tape for sleep. If you snore heavily or may have sleep apnea, see a doctor first.

When Should I See My Healthcare Provider About Exercise-Induced Asthma?

If you or your child are experiencing asthma symptoms triggered by exercise, it is important to speak to your doctor. There are several conditions with similar symptoms, so do get checked out.

If you have severe difficulty breathing, take your reliever medication and seek immediate medical help. You should never stop or change prescribed asthma medication without first consulting your doctor.

If you have shortness of breath with no airway symptoms, it is worth asking your doctor to check your iron levels.

Can Exercise-Induced Asthma Go Away?

If you have exercise-induced asthma, you can live an active lifestyle and even excel at sports. People with a tendency for sports-induced asthma compete in the Olympics and run marathons. There is a lot you can do, and your breathing is a good place to start.

Practice slow, light, and deep breathing, and breathe in and out through your nose. When your everyday breathing improves, many people find their exercise-induced symptoms ease considerably.

How to Unblock Your Nose and Open Your Airways

If you have exercise-induced asthma, you may also have nasal congestion. The good news is, you can often unblock your nose by practicing a simple, gentle breath-holding exercise. Watch the video below.

Breathe Better, Train Without Limits

Exercise-induced asthma is not simply a fitness problem. How you breathe plays an important part. The Oxygen Advantage method helps by retraining breathing patterns through nasal breathing, reduced breathing volume at rest, and gentle breath hold exercises, alongside your medical care.

Start by measuring your BOLT score and use it to track your progress over time, together with how your breathing feels during exercise.

If you are interested in trying the OA method for yourself, why not try our online breathing course, become a certified breathwork instructor, or find an Oxygen Advantage instructor near you.

FAQs

Q: What causes exercise-induced asthma?
A: Exercise-induced asthma is mainly triggered by breathing large volumes of air during exercise, which cools and dries the airways. Breathing cold, dry or polluted air through the mouth makes this more likely. Allergies, airway inflammation and high training loads also play a part.

Q: Can nasal breathing reduce exercise-induced asthma symptoms?
A: Yes. Nasal breathing warms, humidifies and filters incoming air, and nasal nitric oxide has antimicrobial properties. In one study, nasal breathing during moderate exercise almost completely prevented post-exercise bronchoconstriction. At higher intensities, the nose may not be able to supply enough air.

Q: Is the Oxygen Advantage method safe for people with asthma?
A: The gentle breathing exercises are suitable for most people with asthma. Randomized trials of the Buteyko method, on which Oxygen Advantage is based, have shown reduced reliever medication use and improved asthma control. People with asthma should progress gently, avoid strong breath holds if their asthma is severe or uncontrolled, and never change medication without medical guidance.

Q: What is the link between CO2 tolerance and asthma?
A: Some people with asthma habitually over-breathe, which lowers CO2 and may contribute to airway narrowing. In Oxygen Advantage, "CO2 tolerance" is a practical term for staying comfortable with air hunger. Breathing retraining that reduces over-breathing has been shown in trials to help reduce symptoms and reliever use.

Q: Should I use my inhaler before trying nasal breathing exercises for asthma?
A: Keep taking your medication exactly as prescribed, including any inhaler your doctor recommends before exercise. If symptoms flare during practice, stop and use your reliever medication. If your symptoms improve over time, ask your doctor whether your treatment should be reviewed.

References

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