Exercise Induced Bronchospasm (EIB)

Exercise Induced bronchospasm (EIB) was previously known as exercise induced asthma but this term is no longer used as it incorrectly implies that exercise causes asthma. Around 90% of people with asthma also have EIB. However not everyone that has EIB has asthma. 

Symptoms may include cough, wheezing, shortness of breath, upset stomach, chest tightness and sore throat. Coughing is the most common symptom and may also be the only symptom.  Symptoms may not appear until a few minutes into your work out and may then continue for additional 5 to 10 minutes after stopping exercise.  

A common belief is that cold temperatures may cause asthma, but research has shown that it may be more due to dry air then temperature. Cold air tends to have less moisture than warm air, making it drier. When dry air is breathed in quickly this leads to dehydration of the bronchial tubes resulting in airway narrowing (bronchoconstriction).  

EIB may also be trigged by pollution, high pollen and exposure to irritants such as smoke or strong fumes. Chlorine from swimming as well as air temperature during hot yoga may also be triggers.  

Some tips include…. 

Covering your mouth with a scarf if exercising in cold, dry weather.  Ensuring to take your medication prior to exercising and performing a warm up prior to exercise or vigorous activity. 

Warm ups prior to exercise may also help. 

 If you have a child with EIB, ensure that all teachers and coaches are aware.  

Medication options include the following:

-       Short-acting beta agonist. This class includes rescue inhalers such as albuterol, also known as ProAir or Ventolin. These medications should be administered 15 minutes before exercise. This class of medication is considered the treatment of choice for EIB. They should always be on hand to help with breakthrough symptoms. 

-       Long-acting beta agonist include salmeterol (Serevent) and formoterol (Foradil). These medications should be administered at least 30 to 60 min before exercise. When these medications are used for a long period of time protection may be lost after the 12 hour dosing interval. This class of medication is only used for prevention and not treatment and used only once within a 12 hour period.  

-       Mast cell stabilizers include Cromoyln sodium and nedocromil. This class of medication may be used for prevention and exacerbation related to exposure to other asthma triggers. These medications should be administered no greater than 1 hour prior to exercise. 

-       Leukotriene modifiers include montelukast (Singulair). This mediation is taken once daily to help prevent symptoms related to EIB. 

All these medications are prescription only and should be discussed with your primary provider and pharmacist. 

Leukotrienes Role

Leukotrienes are fatty acids derived from arachidonic acid (AA). These fats cause inflammation and during an asthma attack they bind to receptors in the bronchial and airway tissue. This causes bronchoconstriction. 

Leukotriene modifiers include pharmaceuticals montelukast, zafirlukast, and zileuton. These medications block leukotrienes by one of two ways:

1.     Working on mast cells and eosinophils to prevent leukotriene release

2.     Preventing leukotrienes from binding to receptors on bronchial tissues

Fish oil contains omeg-3 fatty acids specifically,  EPA and DHA. These fats have anti-inflammatory properties that decrease inflammation and improve lung function. They work by competing with AA, reducing the synthesis of leukotrienes and also inhibiting the production of AA leading to less inflammation.

Good sources of omega-3 are the following:  salmon, cod liver oil, mackerel and tuna. Just remember that consuming a high diet in fish may increase your risk for mercury poisoning, and therefore moderation is key. 

Look for my upcoming posts about mast cell stabilizers, antioxidants and other supplements that can be used in adjunct to your medications to help reduce asthma symptoms. If you have asthma or symptoms talk to your provider to find a treatment plan that is best for you.

References:

1.     https://pubmed.ncbi.nlm.nih.gov/2844278/ Accessed on May 19, 2020

2.     https://pubmed.ncbi.nlm.nih.gov/7926711/ Access on May 19, 2020