Can You Safely Play Sports With Asthma?

Not being able to breathe easily can be a scary experience for anyone, especially children. If you or your child can generally breathe at rest but notice unpleasant symptoms, such as wheezing or coughing, when you exercise, you may have asthma sports. 

Although sports asthma can impact your performance when exercising and be worrisome for parents who have children affected by it, it’s typically safe for people with sports asthma to continue exercising. It can be prevented and managed with the help of your healthcare provider. 

What is exercise-induced asthma?

Exercised-induced asthma, also known as exercise-induced bronchoconstriction¹ or sports asthma, occurs when the airways of your lungs narrow due to strenuous physical activity. While sports asthma is referred to as asthma, that’s not exactly what it is. 

For people with sports asthma, their airways narrow exclusively when they exercise. In people diagnosed with asthma, physical activity is likely only one of several factors that could bring on asthmatic symptoms. 

Sports asthma can be annoying for people who enjoy exercising and scary for parents of children who experience it. The good news is that it’s safe for most people with exercise-induced asthma to continue maintaining an active lifestyle by managing their symptoms and taking medications if necessary.

What are the symptoms of asthma sports?

Symptoms of sports asthma can vary from person to person. Additionally, these symptoms can occur during or after exercise and can last up to an hour or longer if not treated.

Common symptoms of sports asthma include:

• Shortness of breath

• Wheezing

• Coughing

• Tightness or pain in the chest

• Feeling tired during exercise

• Unusually poor athletic performance

• Avoiding physical activity (typically seen in children)

Causes of sports asthma

The cause of sports asthma may seem obvious: exercise. While this is true, other factors could contribute to someone developing symptoms of exercise-induced asthma. 

For example, it’s common for sports asthma symptoms to worsen when:

• The air outside is dry and cold

• Poor air quality as a result of surrounding pollution levels

• High pollen counts

• Inhalation of chemicals, smoke, or other fumes from urban traffic  or industrial areas

It’s also worth noting that you’re more likely to breathe through your nose when you are at rest. As a result, your nose moisturizes and warms the air you breathe through your nostrils. 

On the other hand, when you’re exercising, you’re more likely to breathe through your mouth. This keeps the air dry and cold. 

For people with sports asthma, this cold, dry air can lead to the bands of muscles surrounding your airways constricting, making it harder to breathe. However, some studies have found the opposite, that nasal breathing was protective against exercise-induced bronchospasm, particularly in patients with allergic rhinitis.

Exercise-induced asthma can affect anyone; however, it’s more likely to develop in people with asthma. It’s estimated that up to 90%² of people with asthma also have sports asthma. Likewise, it’s particularly common in people who play high-level sports. 

How is sports asthma diagnosed?

If you or your healthcare provider suspects that your child could have sports asthma, they will likely perform a physical exam and a series of tests to determine the cause of their symptoms. 

These tests could include the following:

Spirometry

Spirometry is used to determine how well your lungs are performing when you’re not undergoing physical activity. A spirometer is a device that measures the amount of air you breathe in, how much air you breathe out, and how quickly you can breathe out.

After observing your lung function when you’re at rest, your healthcare provider may have you do the test one more time after using an inhaled medication, called a bronchodilator, to open your lungs up. They will then compare the results from both tests. 

Exercise challenge test

This test will require you to exercise, typically on a stationary bike, for about 8 to 12 minutes, getting your heart rate up to 80% to 90% of the predicted maximum. Then your healthcare provider will observe how your expiratory rates and volumes are affected. 

It’s essential that whatever physical activity you undergo is intense enough to trigger your exercise-induced asthma symptoms.

How is sports asthma treated?

Unfortunately, sports asthma cannot be cured. Because of this, treatment is used to prevent and manage the symptoms that develop during or after exercising. 

Working closely with your healthcare provider is the best way to manage your exercise-induced asthma. You and your healthcare team can create an individualized treatment plan that meets your specific needs. 

You may wish to warm up before exercise. However, the role of pre-exercise warm-up is unclear, with conflicting data. Your healthcare provider may recommend one or more medications to help open up your airways when you're physically active. 

These medications may include:

Short-acting beta-agonist 

The short-acting beta-agonist (SABA) medication is a type of bronchodilator. It’s used to relieve exercise-induced asthma symptoms during an episode. 

Also known as rescue inhalers, this medication is breathed in and goes directly to your narrowed airways. It’s also possible for this medication to prevent symptoms if you take it fifteen minutes before exercising. 

Long-acting beta-agonist (LABA)

The long-acting beta-agonist (LABA) medication acts like SABA medications by relaxing the muscles of your airways and letting air flow in. You should take the LABA medication thirty minutes to an hour before exercising. 

It’s important to note that this type of medication is not a rescue inhaler. Because of this, it should not be used once symptoms have begun. 

This can be particularly useful for patients exercising for longer than three hours or more than twice daily. However, recent guidelines no longer suggest LABA use alone, as the benefits diminish over time.

Leukotriene receptor antagonists (LTRAs)

These medications are taken orally to prevent your airways from becoming inflamed, which can often contribute to asthma symptoms, including sports asthma.

Inhaled corticosteroids

These medications increase the airflow to your lungs by reducing the inflammation in your airways. 

Ipratropium

This medication is inhaled and demonstrated effectiveness in elite cross-country skiers. 

Which sports are best for people with asthma?

Even though sports asthma can typically be managed and prevented, certain activities or sports may be better options for people with exercise-induced asthma. 

Here are some examples of sports that may be less likely to induce asthma symptoms:

• Golf

• Tennis

• Yoga

• Gymnastics

• Fencing

• Bodybuilding

Similarly, other sports may increase the chances of a person diagnosed with exercise-induced asthma experiencing symptoms. 

In particular, endurance sports or those that encourage using a lot of energy without having much rest time in between, as well as sports that occur in dry and cold weather, including:

• Long-distance cycling or running

• Triathlon

• Swimming

• Ice hockey

• Skiing

How to play it safe when you have asthma

Before participating in any sports, it’s vital to get your asthma symptoms under control by working closely with your healthcare provider and taking your prescribed medications. Be sure to bring any long-term control medications you’ve been prescribed, even if you feel fine. Failing to do so could make your symptoms worse.

If you’re experiencing flare-ups, it’s best to wait until your asthma symptoms have subsided before engaging in physical activities again. In addition, it’s essential to have your rescue inhaler and other fast-acting medications with you wherever you go, particularly when you intend to exercise.

This will allow you to take it if and when you need it. If your healthcare provider has instructed you to take your fast-acting medication before working out, be sure to do so.

Letting your healthcare provider know your exercise plans for the future, such as playing sports or participating in a workout routine, is an excellent way to ensure you’re well-prepared for them. 

Your healthcare team may make suggestions to help prevent a sports asthma flare-up, such as:

• Avoiding working out outdoors when the air quality is poor or pollen counts are high

• Wearing a mouth covering, such as a scarf or a mask, when exercising outdoors during the winter

• Exercising when urban traffic is low and avoiding exercise when air quality indices are high

It’s also a good idea to let the people who will be exercising with you know about your sports asthma condition, including your coach and teammates. This will help them understand why you may need to take a break or use medications if you experience symptoms of a flare-up. 

The more familiar you become with the symptoms and triggers of your exercise-induced asthma, the better you’ll be at preventing and managing them when you feel them coming on.

How to make sure your child is safe while playing sports 

If your child has been diagnosed with exercise-induced asthma, they need to have an Asthma Action Plan before engaging in physical activity. Your child’s coach should have a copy of this action plan and any other adults who may be in charge of them while they participate in sporting events. 

Discuss your child’s needs with the coach at the beginning of each sports season. This should include what to do in an emergency and what is likely to trigger your child’s asthma sports symptoms. 

If your child does develop asthma symptoms while exercising, they must have quick access to their rescue inhaler. Be sure they know where their asthma medications are and how to use them properly.

What is an Asthma Action Plan?

Equipping your child with an Asthma Action Plan³ is the best way to ensure that they and the people around them know exactly what steps to take if they experience worsening asthma symptoms. 

Your healthcare provider creates an Asthma Action Plan to keep your sports asthma under control. Ideally, following the Asthma Action Plan will not only prevent flare-ups while exercising and help effectively manage them if they occur.

Writing down the specific steps your healthcare provider recommends that a person should take if their child needs asthma treatment can take the pressure off of you, your child, and the adults responsible for them to remember every detail. 

It’s best to bring your child's Asthma Action Plan with them wherever they go in case a flare-up occurs. 

Asthma Action Plans are catered for each person, so yours may differ from someone else’s. They will all have certain factors in common, such as what to do if the person experiences a flare-up, what medications to take and when, and when to seek emergency medical care. 

It’s important to note that the success of an Asthma Action Plan depends on the fact that you’ll follow it as directed, even when you feel normal. 

It’s important to discuss your symptoms, lifestyle, and other concerns with your healthcare provider so they can alter your Asthma Action Plan as needed.

The lowdown

If you or your child experiences coughing, wheezing, or difficulty breathing when you exercise or play sports, you may have sports asthma. Exercise-induced asthma can be annoying and scary, particularly for parents watching their children struggle to breathe, but it can usually be managed and prevented. 

By working closely with your healthcare provider, following your Asthma Action Plan, and taking your medications as prescribed, you or your child can continue to exercise and play sports without being held back by constricted airways.