How to Manage Exercise-induced Asthma in Cold Weather

Man Warming Hands During Winter Workout
 Peter Muller

Let’s face it: exercising in the winter sucks. Running outside in freezing temperatures is a chore, the treadmill and stationary bike get boring in a hurry, and exiting the gym after a shower leaves you with frozen, crunchy hair.

But for the millions of people with exercise-induced asthma, those annoyances are the least of their problems. The cold, dry winter air is a major trigger that constricts their airways and makes breathing difficult. The end result: shortness of breath, coughing, wheezing, a tight chest, and decreased endurance.

Exercise-induced asthma—or, more correctly, exercise-induced bronchospasm, or EIB—affects roughly 8 in 10 Americans with a diagnosis of asthma and 1 in 10 Americans in the general population, although these numbers may be higher, given that many people are not aware that they have the condition, especially if they have a milder case.

Contrary to what the name might suggest, exercise itself isn’t the trigger for EIB. Rather, it’s the rapid inhalation of air that can constrict and inflame the airways and cause the coughing, wheezing, and other symptoms. Inhaling lots of cold, dry air in winter makes it worse, according to Dr. Amy Simon, director of the Asthma Center at Tufts Medical Center in Boston. That’s why a much greater percentage of Winter Olympians who participate in high-intensity sports—like cross-country skiing—have EIB compared to their Summer Olympic counterparts.

Yes, that’s right: Winter Olympians, including Apolo Ohno, owner of eight Olympic and 20 World Championship short track speedskating medals. And Summer Olympians, including swimming medalists Amy Van Dyken, Tom Dolan, and Peter Vanderkaay. And NFL stars, like Steelers Hall of Fame running back Jerome Bettis, who had a near-fatal attack in a game in 1997.

Vanderkaay, who won two individual bronze medals and two relay gold medals at the 2004, 2008, and 2012 Olympics, was diagnosed at age 10 and struggled with both asthma and EIB (up to 90% of people with asthma also have EIB).

“I didn’t manage it well as a youngster,” Vanderkaay says. “I took it a lot more seriously when I got to college, because I had to. It was keeping me from going to the next level.” His condition didn’t keep him from reaching the very highest level, though.

So if you have symptoms of EIB or asthma, don’t give up and avoid exercise. The key is getting a diagnosis, following a treatment plan, and taking preventative measures to limit flare-ups.

Diagnosing EIB

Doctors use several methods to diagnose EIB, often starting with a patient history to determine what symptoms patients experience and if they occur exclusively around exercise. Exposure to allergens and irritants in the environment can also be a cause, which is why allergy tests are done on some patients. For Vanderkaay, who has two brothers who also have asthma and had successful swimming careers, both genes and the environment of the pool might have played a role. Chlorine can be a trigger, according to Simon. “If there is a high level of chlorine or its byproducts, which can form an aerosol at the pool surface, this can irritate the airways and incite symptoms in some people,” Simon says.

For a more definitive diagnosis of EIB, doctors use a spirometry test. Patients blow into a spirometer to set a baseline for their lung capacity and volume, then blow into it again at various points after they begin exercising, because symptoms often begin 10-15 minutes or so after starting exercise.

“We check how much air someone can push out of their lungs in one second,” Simon says. “What we look for is a significant drop with exercise. Whatever they came in at, did it fall by 15% with exercise? That’s usually positive. If someone falls 10%, that’s suggestive, but it’s a slam dunk (or diagnostic) if it’s 15% or more.”

Treatment

That formal diagnosis is important for everyone to get proper treatment, but especially for Olympic athletes, who need to be careful to only take approved drugs and dosages. In cross country skiing, where the high breathing rate and cold air contributes to EIB diagnoses among as many as half—half!—of elite athletes, a Norwegian skier was stripped of a World Cup title after allegedly taking salbutomol doses 20 times the allowed amount, and three other undiagnosed team members were reportedly taking asthma medications.

For the regular Joe, a few puffs of salbutomol (also known as albuterol, a beta2 agonist/bronchodilator), either 15 minutes before exercise to prevent symptoms or right after exercise, is a common treatment, Simon says. Another common medication is leukotriene antagonists, anti-inflammatory bronchoconstriction preventers. These drugs, such as montelukast (brand name: Singulair), are taken in pill form a few hours before exercise. For more mild cases caused by an allergy, an anti-histamine, such as a loratadine (brand name: Claritin) pill may suffice. “For some people who have known allergies, that can work particularly well,” Simon says.

More and more medications and strategies are being developed to help understand and treat EIB and asthma. “We’re learning a lot about asthma, and as a result there are many new, interesting treatments based on the phenotype of the patient,” Simon says. “We’re really honing in on the fact that asthma isn’t one disease. It’s due to multiple genes that interact with multiple environmental factors. If I have 15 different patients, 15 different types of asthma could potentially be identified.”

Nonmedical prevention

Because rapidly inhaling cooler, dryer air is a main culprit of EIB, Simon encourages wearing a mask or scarf when exercising outdoors—anything to warm the air before it enters the lungs. For some people, a gentle warmup may also be helpful. Other people try homeopathic solutions such as vitamin C, fish oil, and a low-salt diet, although Simon says studies on these treatments have been inconclusive.

A breath of fresh air

Most important, say Simon and Vanderkaay, don’t let EIB prevent you from exercising and pursuing your athletic goals.

“Don’t let it stop you,” Vanderkaay says. “Keep working on your dreams and don’t forget that you can do it. It’s a matter of getting the right care and understanding what the problem is, having a conversation with a health care professional to see what treatment is right for you.