In short: Shortness of breath during training, reduced endurance or a feeling of running out of air also occur in young, fit people. A common cause is exercise-induced asthma, but there are other causes, and a targeted work-up usually leads to an answer and to treatment that gets you back to training.
Common causes
- Exercise-induced asthma: wheezing, cough or chest tightness during exercise or right after it
- Exercise-induced laryngeal obstruction (EILO, formerly called VCD): difficulty mainly when breathing in, with noisy breathing from the throat at peak exercise, which settles quickly at rest and do not improve with inhalers
- An inefficient breathing pattern
- Cardiac causes, including arrhythmias
- Anaemia and iron deficiency
- Training overload and accumulated fatigue
- After-effects of a viral infection
How it is evaluated
We start with a detailed consultation: when the difficulty appears, what it feels like and how long it lasts. This is followed by spirometry, FeNO and blood tests and, where needed, a bronchial challenge test to diagnose exercise-induced asthma. A cardiopulmonary exercise test (CPET) shows, during exercise itself, what is limiting you: the lungs, the heart, the muscles or the breathing pattern. The test is performed at a dedicated testing centre, and we interpret it. When laryngeal obstruction is suspected, the evaluation is done together with an ENT specialist, sometimes with continuous laryngoscopy during exercise (CLE).
Treatment
- Exercise-induced asthma: an inhaler before training and, if needed, regular treatment, preferably including an inhaled corticosteroid, plus a gradual warm-up
- Laryngeal obstruction: breathing training with a speech and language therapist or a respiratory physiotherapist
- Inefficient breathing pattern: breathing training
- Treating the cause, when it lies outside the lungs
For competitive athletes, it is important to make sure treatment complies with the rules of the World Anti-Doping Agency (WADA). Most inhalers are permitted, some only up to a set dose, and others require a Therapeutic Use Exemption (TUE).
Frequently asked questions
I have asthma. Can I run a marathon?
Usually yes. When asthma is well controlled, most people with asthma can train and compete at any level.
My inhaler doesn't help when I run. Why?
The difficulty may be caused by something other than asthma, for example exercise-induced laryngeal obstruction or an inefficient breathing pattern. This is exactly why a structured work-up matters.
Related topics
General information only; it does not replace a medical consultation. עברית