Wheeze, sneeze, compete: Athletes and asthma

May 1, 2018 Allison Milionis


An elite athlete reaching for an asthma inhaler to ward off wheezing may be incongruous with your idea of what it means to be extremely fit, but unfortunately, it’s fairly common. Exercise-induced asthma affects an estimated 20 to 50 percent of all athletes, from marathon runners to Olympic skiers.

In fact, asthma occurs more frequently in athletes than in the general population, and it’s more prevalent in elite athletes than in people who play recreational sports. Athletes who participate in endurance events, swimming and winter sports are particularly susceptible.

Unlike chronic asthma, which is caused by ongoing inflammation in the airways, exercise-induced asthma, or exercise-induced bronchospasms (EIB), is triggered by strenuous exercise. The airways in the lungs narrow, causing a range of symptoms, such as shortness of breath, wheezing, coughing, chest tightness and fatigue.

The signs and symptoms of exercise-induced asthma can begin during or a few minutes after starting exercise, and persist for 30 minutes or longer if left untreated.

“We don’t understand why competitive athletes have a higher incidence [of asthma] than the general public,” said John Mastronarde, M.D., a pulmonologist with Providence Sports Medicine and The Oregon Clinic in Portland, Ore. “There’s more research to be done.”  

Swimming with asthma

Sybil Hedrick Park, a master swimmer and occupational therapist with Providence Sports Medicine knows all about asthma. As a young collegiate swimmer, she developed exercise-induced asthma during her workouts.

“I had chronic bronchitis for a few years and I don’t know if that facilitated it [asthma]. All of a sudden I couldn’t swim and breathe so I sought medical help, got diagnosed and learned to manage it. I had to use an inhaler when I was swimming, but not outside of swimming,” she said.

Hedrick Park managed her asthma so well, she swam the English Channel in 2003. “It was a complicated process with asthma,” she said. “At some point during the swim, I had to slow down because my asthma was kicking in.” Yet in spite of the challenges, Hedrick Park completed the chilly 21-mile swim.

Accurate testing

Symptoms alone are not enough to accurately diagnose exercise-induced asthma in athletes. “Often it’s misdiagnosed. There are other things that can act like asthma or cause some of the same symptoms,” Dr. Mastronarde said.

For this reason, Dr. Mastronarde emphasized the importance of objective testing.  Although there are a number of reliable tests, he uses the eucapnic voluntary hyperventilation (EVH) test, which is also endorsed by the International Olympic Committee. The EVH test mimics the effect that prolonged exercise has on the airways. The patient rapidly breathes a specific gas mixture for six minutes.

“It simulates high-intensity hyperventilation, which is part of exercise,” he said. “If you have exercise-induced asthma, your lung function will drop by a certain amount [during or immediately following the test].”

Awareness and treatment

Dr. Mastronarde said more people experience asthma or asthma-like symptoms during spring and summer, the height of outdoor activities (particularly in colder climates) and allergy season.

He recommends taking precautions, avoiding conditions or situations that can trigger an uncomfortable reaction. For example, if you have a grass allergy, don’t do your sprints on a fresh-cut field.

Parents with active kids and teens should also be aware of symptoms that may be caused by asthma: coughing, wheezing, shortness of breath or tightness in the chest. Dr. Mastronarde highly recommends that kids or teens experiencing these symptoms be evaluated by a professional who focuses on asthma.

Get an expert’s opinion

An asthma diagnoses doesn’t mean the end of exercise or sports. With prevention and management, you don’t need to slow down or throw away your dreams of competing at a professional level.

If you or a loved one have persistent breathing problems despite warming-up and preventive medications, or are unable to reach exercise goals due to breathing problems, see a specialist. If you live in the Portland area, The Oregon Clinic Asthma Center is a good place to learn more and be EVH tested.


To learn more about Providence Sports Medicine and the range of services offered there, click here.

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