Asthma and exercise-induced narrowing of the airways (EIB) is very common among high-level endurance athletes. Performing endurance sports in cold, polluted air or in warm, humid swimming pools with chronic exposure to chlorine are clear triggering factors. More than 50% of cross-country skiers report EIB or asthma.
EIB is less commonly seen in younger athletes. The first symptoms often manifest after the age of 20 or 25. The fact that elite endurance athletes ventilate a lot of air per minute can also contribute to the development of EIB.
It is suspected that the loss of moisture during intense ventilation plays an important role. (Kippelen P 2020)
(Anderson S.D. and Kippelen P. 2005)
What is exercise-induced narrowing of the airways?
During intense exercise, the airways narrow. This narrowing reverses when the exercise stops. This complaint can occur in perfectly healthy individuals but is also seen in people who suffer from asthma. Athletes who have EIB often experience other symptoms, such as coughing, chest tightness, shortness of breath, and excessive mucus production during exercise. (Kippelen P 2020)
Who suffers from EIB?
Approximately 8% of Olympic-level athletes suffer from asthma and/or EIB. It is the most common complaint among professional athletes. EIB is more commonly seen in elite athletes than in recreational athletes. (Kippelen P. 2020)
Testing for EIB?
It is crucial that the diagnosis of EIB is made based on objective testing, not just a conversation with the doctor. A diagnosis of EIB based solely on symptoms is often found to be incorrect. A pulmonary function test should be the first test performed on individuals with these complaints. Because endurance athletes often have very good lung function, a bronchoprovocation test is needed to test for EIB. During a provocation test, bronchoconstriction is induced by maximal exertion, eucapnic hyperventilation.
- Pulmonary function before and after a maximal exertion test
- Pulmonary function before and after using an inhaler
- Bronchoprovocation test
Treatment of EIB
EIB is a condition where airway inflammation may play a role. If there is inflammation of the airways, inhaled corticosteroids are needed. These inhaled corticosteroids are not effective if there is EIB without inflammation of the airways (Kippelen 2020).
In our practice, we see a very positive effect from combined breathing and mental training. We believe that this has a significant effect on athletes with exercise-induced asthma because we suspect that a dysfunctional breathing pattern is a very important factor in the development of exercise-induced asthma. Mental training is important because there is often a significant lack of confidence in the breathing system.