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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


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Taking the Sneeze and Wheeze Out of Exercise


July 09, 2013

By Paulette Chandler M.D.

Brigham and Women's Hospital

Pollen, air pollutants, respiratory infections, even cold air can make exercising difficult for people with asthma and allergies. But don't let them stop you. Exercise is excellent medicine even if you have severe asthma or allergies — it strengthens the lungs and heart, improves circulation to all the tissues, including the brain, and cleans out waste products that build up from chronic respiratory problems. What's more, it helps overweight people lose a few pounds, which can open up the airways and further improve lung function.

The keys to exercising with asthma or allergies are preparation and awareness of yourself and your environment. The suggestions below are a good start, but they shouldn't take the place of a conversation with your physician about setting up a treatment program that will be effective during exercise.

Preparing for Exercise

  • Open your nasal passages and calm "twitchy" airways before starting your exercise routine. If your nose is clogged, you'll breathe through your mouth, bypassing the important filtering that goes on in your nose. This lets lots of pollutants, irritants and allergens into your lungs. A non-sedating antihistamine, nasal cromolyn or nasal steroid may help to open your nasal passages. Irrigating your nasal passages with a saline solution or inhaling steam also may help. Using an albuterol inhaler may help people with asthma open their airways and control airway spasms.

 

  • Pick a good place to exercise. Depending on your allergy or asthma triggers, avoid fields of grass and weeds, busy roadways with lots of exhaust fumes, or indoor spaces that contain molds or noxious or irritating odors.

 

  • Drink plenty of water before exercising.

 

  • Carry an injectable form of epinephrine and wear a medical alert bracelet if you have exercise-induced anaphylaxis (shortness of breath, sensation of throat closing) or severe allergies to stinging insects such as bees or wasps. Don't wear brightly colored clothing or fragrances that may attract stinging insects.

Strategies for Exercise

Asthma and allergies need not hold you back from excelling in, or at least enjoying, any sport you choose. That said, some sports are better than others for people with asthma or allergies.

Swimming is a great choice for several reasons. The moist air over indoor pools is usually low in allergens. The body's horizontal position may help clear mucus from the bottom of the lungs. Walking, bicycling and yoga are also good options. Regularly and healthily conducted exercise may reduce the need for asthma medications.

Short bursts of intense activity, such as sprinting, are less problematic for people with asthma than continuously intense activities, such as marathon running. If you choose to run, an indoor track may help to reduce exposure to pollutants and other triggers.

Here are some tips for safe, healthy exercise:

  • Give yourself plenty of time to warm up before exercising and to cool down after it. This is an excellent way to prevent exercise-induced asthma, or to minimize its symptoms.

 

  • Don't overexert yourself. Pay attention to how you feel. If you are gasping for breath and unable to talk, or experiencing significant discomfort in your body, you should slow down.

 

  • Keep yourself hydrated — bring along plenty of water to drink as you exercise and after you stop.

Picking the Best Time To Exercise

Try to exercise when the air is as clean as possible. Avoid intense exercise when ozone levels are high. This is usually in the early afternoon, especially on hot, hazy summer days. Levels are usually lowest in the early morning and at dusk. If you have exercise-induced asthma, cold weather or warm, humid weather can trigger symptoms. Some people get symptoms if there's a lot of pollen in the air. Others develop symptoms if they have taken aspirin or some other nonsteroidal anti-inflammatory drug such as ibuprofen before exercising.

Keep track of daily allergy, ozone and pollutant levels in your area by checking the area weather report through one of the weather media sources such as the Internet or radio.

What Is Exercise-Induced Asthma?

Some people cough, wheeze and get short of breath only when they exercise. This is exercise-induced asthma. It's often mistaken for being out of shape. Exercise-induced asthma commonly occurs with intense exercise or when exercising in cold air. Although the symptoms often appear right away, they can occur hours after you've stopped exercising.

Paulette Chandler, M.D., M.P.H., is a clinical instructor of medicine at Harvard Medical School and an attending physician at Brigham and Women's Hospital.

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