FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S COUGHING MIGHT BE "EXERCISED-INDUCED" ASTHMA

Question: I start coughing every time I exert myself outside in the winter weather. The coughing has been severe enough that I've stop my daily jogging. I have mild asthma, but I cough, not wheeze, when I exercise. What is causing this coughing?

Answer: As you know, it requires more frequent and deeper breaths to maintain a higher level of physical activity like your jogging. This level of physical activity is called "aerobic" because of the extra "air" that is required to do it. All of us should have at least 30 minutes of aerobic activity at least three days a week to maintain a healthy level of physical fitness. So, your regular jogging contributes to your good health.

Individuals with asthma are prone to coughing as well as wheezing when their lungs are irritated. Your coughing is probably a result of your asthma rather than an infection or some other cause. All individuals with asthma are, to some extent, likely to start coughing and develop shortness of breath when they exercise. This condition called exercise-induced asthma also affects many people who don't consider themselves asthmatic. For instance, about 35-40 percent of those who have "hay fever" and don't suffer from other types of asthma can have this exercised-induced variety. Studies have shown that as many as 14 percent of high school athletes with no previous history of asthma or allergies have this condition. It is also more common in those who are overweight.

There are two things associated with cold weather that may help to bring on your coughing. First, the very low moisture content of winter air dries the bronchial tissues, particularly with the deep and rapid breathing associated with exercise. Second, the cold air itself is another irritant to the lungs. While the drying effect of deep and rapid breathing can also occur in warm weather, the one, two punch of dry air and cold air make exercise-induced asthma more common in the winter.

Question: Is there anything I can do to prevent coughing when I exercise outside in the winter?

Answer: Wearing a face mask or scarf over the nose and mouth while exercising will help slow the loss of needed moisture and help warm the air you breathe. This may give you sufficient relief from your coughing your exercise induced asthma when the temperatures are cool, but it won't work when the air is very cold and dry. For days when the weather is worse or your asthma is acting up, you will need added medication.

Several medications can prevent or reduce the severity of exercise induced asthma. Ipratropium bromide, cromolyn sodium, albuterol and others work well for most individuals, although one medication doesn't work well for everyone. An alternative to increased medication is to exercise indoors where cold air won't be a bronchial irritant. However, exercise induced asthma may still be a greater problem in winter than it is at other times of the year because the indoor air is usually even drier than outdoor air. Talk to your family doctor. He or she can help you work out a plan that will keep you physically fit in the winter and keep your asthma under control.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.