Recently I received two questions to my "Ask The Experts" column on America Online related to asthma. And those weren't the first. Exercise-induced asthma seems to be a growing problem for today's runners. Because of the importance of this subject, I took extra time crafting my response, and I have decided to post the information here on my web site to help runners who might suffer from this performance-limiting problem.

Exercise-induced asthma seems to be a common problem among runners. One study published recently in Science magazine suggests that the incidence of asthma has doubled in the past two decades. One reported cause is that younger people now suffer fewer childhood infections, such as whooping cough and tuberculosis. Apparently, such infections trained the immune system not to react to irritants such as dust and pollen. Without such infections, you're more likely to suffer problems from asthma and other allergic reactions. (Win some, lose some.) The study suggests that we might be able to limit asthma attacks by using a TB vaccine, but scientists are not yet ready to endorse that approach.

Asthma should not be taken lightly. Reportedly, 5,000 Americans died from asthma attacks in 1995, a 44% increase in only a dozen years. According to the National Institutes of Health, asthma cases are up 34% during the same period. It's particularly a problem with children in larger cities. Blacks and Latinos seem to be more susceptible. Twelve million Americans have asthma.

Causes and Cures Why do we get asthma? Genetics is a factor. If your parents have asthma, that increases your chance of getting it too. In an article in the November 10, 1996 issue of Parade magazine, Earl Ubell identified the factors most likely to trigger an asthma attack: cigarette smoke, auto exhaust, pollen, household dust, animal dander (dandruff) and insects. Other causes: infections (a cold or the flu), stress, allergies and (in your case) exercise. Air conditioning, in some cases, can contribute to the problem by recycling the same air. "Inhaling irritants can inflame the airways, or bronchi," Ubell explains. "Mucous builds up. The muscles surrounding the bronchi tighten or spasm, and the airways become narrower." Symptoms include: wheezing, chest tightness and coughing.

Muscle-relaxing spray drugs (bronchodilators; more on that later) can relieve symptoms for runners with mild asthma. For those with more severe symptoms, steroid-based drugs can help. (If you're likely to win an Olympic gold medal, check with the USAT&F; drug hot-line before using them.) There's no evidence favoring vitamins. Changing your diet would help only if some food allergy is causing your problem.

I coached a high school runner named Megan Leahy, who had several attacks of exercise-induced asthma in races her freshman. She'd be running with the leaders, then all of a sudden: boom! Megan and her mom worked closely with a physician to adjust her medication. By her sophomore year, Megan had fewer problems. In her junior year (when I no longer was coaching her) she and her mom located a physician who was a runner (Dr. James Harris, an allergist in South Bend, IN). Dr. Harris gave her a pulmonary function test. Megan's mom mother continues the story:

"Dr. Harris was amazed at Meg's very limited lung capacity: 30 percent of normal. He couldn't believe that she could even run, let alone run at her level of achievement. He prescribed inhaled steroids: Beconase (nasal) and Beclovent (mouth inhaler). These are prophylactic in that they actually help heal the inflamed tissue. She used a personal function testing unit at home, and we could see gradual improvement. If her level fell significantly, we would call Dr. Harris, and he would sometimes prescribe Prednisone for a day to immediately reduce the inflammation. She also would use a Ventolin inhaler about a half hour, and also five minutes, before a race (a half hour before a work-out). This inhaler does not cure the disease, but rather opens the bronchial passages making breathing easier. When Meg was a freshman, she often carried her inhaler like a security blanket. Later, she never carried it, because if she had an attack in a race, stopping and using the inhaler wouldn't be very effective. By the time the inhaler kicked in, the race would probably be over."

Preventing Problems

Megan finished second in the state in cross-country her senior year. Now in college on an athletic scholarship, she still suffers an occasional bad race, when her asthma kicks in. I also asked Megan to comment on exercise-induced asthma:

"I generally experience more asthma difficulties when I go out too fast, so I prefer to gradually increase my speed through the race: either a steady, even-split race or an increasing pace. Depending on whether allergies are involved, I have more problems during the fall (mold) and spring (pollen) than during the winter and summer. Colder weather also seems to give me more problems. I carried my inhaler for three years during workouts in high school, but rarely used it. At that time, it was illegal to use it during a race. I find it best to try to relax, breathe as deeply as possible, try to concentrate on my form, and even slow down if necessary."

In response to a question as to whether or not she might become "addicted" to her inhaler (in the sense that it would become a psychological crutch), Megan responded: "I think that is a legitimate concern. That's why I usually follow very closely the dosage prescribed by my doctor. It works well for almost all conditions: two puffs 45 minutes before a race, then an additional one to two puffs five minutes before. It usually takes a while for the inhaler to take effect as a preventative measure, so you need to make sure your bronchial tubes are dilated before you start to run."

If you have exercise-induced asthma, you can't go it alone or depend on self-medication. You very definitely need to consult with a physician, such as Dr. Harris, who understands the problem and knows how to treat it.

Copyright © 1997 by Hal Higdon. All rights reserved. Requests to reprint will be considered.