Asthma and competitive sport

Exercise is a common trigger for asthma symptoms. However, asthma and sport can mix successfully, as long as you work at maintaining good overall control of your asthma and are aware of the restrictions that may be placed on your asthma medicines by your sporting organisation.

Many sportspeople with asthma have achieved acclaim at the top level of their sport, including Jana Rawlinson (nee Pittman) and Matt Shirvington. Being physically fit may mean that you can exercise more intensely before developing asthma symptoms compared with someone who is unfit. So don’t let your asthma hold you back!

What is exercise-induced asthma?

Exercise-induced asthma (EIA) is airway narrowing brought on by vigorous exercise. The symptoms of EIA — wheeze, breathlessness, cough or chest tightness — may start during exercise but usually worsen in the 5–10 minutes after you stop exercising. During exercise, your lung function is usually only slightly diminished; however, this can impact on your performance if you play competitive sport.

Some people with exercise-induced asthma do not have asthma symptoms unless they exercise. Other people have asthma symptoms in many situations, including exercise.

Exactly how EIA happens is not clear. However, it is thought that EIA may involve loss of heat and water from the airways, as they try to warm and moisten large volumes of incoming cool dry air. The cooler and drier the air you breathe in, the more severe the symptoms of EIA. Rewarming of the airways after exercise is also put forward as a cause of EIA.

If you train intensely and frequently, especially in cold dry air, your risk of developing EIA increases. Other factors that make EIA more likely are allergens (substances that can trigger an allergic reaction, such as pollen) or irritants in the environment. Swimming can be a mixed blessing — the warm humid air reduces the risk of EIA, but some athletes react to the chlorine in indoor pools.

Diagnosis of EIA

Your doctor may suggest lung function testing to see whether you have EIA and, if so, how severe it is. Generally, your lung function would be assessed before exercise (for example, running on a treadmill) and then repeated several times after exercising.

Other tests are sometimes used to diagnose EIA; some involve inhaling various irritants to see whether your airways react to them.

Medicines for EIA

Your doctor may prescribe asthma medicines to help prevent EIA. Inhaled corticosteroids (preventers) often effectively reduce the severity of EIA, but they take 2–3 months to have their full effect. You will therefore probably need other medicines during this period — and possibly on an ongoing basis — your doctor may suggest various medicines including long-acting beta2 agonists (symptom controllers) and short-acting beta2 agonists (relievers, used just before exercise). If your EIA is mild, these medicines may be given on their own.

Other preventer medicines that your doctor may suggest are sodium cromoglycate (Intal, Intal Forte), nedocromil (Tilade) or leukotriene receptor antagonists such as montelukast (Singulair) or zafirlukast (Accolate).

Asthma medicines and drugs-in-sport rules

A key element in combining sport and asthma is knowing the conditions that will be placed on the use of your asthma medicines by your sport’s governing body.

Any medicines that you take, whether prescribed by your doctor or obtained over the counter, can be considered by your national sporting organisation to be either:

  • banned in your sport;
  • permitted in your sport subject to certain conditions;
  • permitted for females only; or
  • permitted in your sport.

In all instances, before taking a medicine, find out the status of that medicine in your sport and/or in a particular competition in which you are entered by:

  • making sure that your doctor checks that all your prescribed medicines are permitted in competitive sport (it may be best to see a sports doctor);
  • contacting the Australian Sports Anti-Doping Authority (ASADA) regarding all over-the-counter medicines;
  • asking your national sporting organisation — as rules on permitted medicines may vary from sport to sport; and
  • contacting the World Anti-Doping Agency if you are competing internationally.

What to do if you need a prohibited medicine for your asthma

If your asthma requires you to be treated with a medicine that is prohibited in your sport, you may be able to take that medicine while competing if you obtain a Therapeutic Use Exemption — contact ASADA or your national sporting organisation for more information. At the time of writing, this applies to inhaled corticosteroids and beta2 agonists, but make sure you check with ASADA because the list of banned medicines may be revised from time to time.

You may need to provide medical evidence that you have EIA in order to use some asthma medicines during competitions.


ASADA advises athletes to be wary of nutritional supplements, as they may contain impurities or banned substances not listed on the label. Athletes are held liable for any substance found in their body, even if they are unaware that a banned substance is present in a medicine or supplement.

Preventing EIA

The National Asthma Council advises the following methods to help prevent EIA:

  • keep as fit as possible;
  • exercise in an environment that is warm and humid;
  • avoid exercising in environments where the air contains a lot of allergens or irritants;
  • try to breathe through the nose or consider using a mask; and
  • make sure you warm up well before exercising.

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