Fifteen minutes into practice, while everyone has warmed up, you’re winded. Could be you’re just plain out of condition… or it could be that, like 10 % of the gold medal winners in the 1984 Olympics, you have exercise-induced asthma. Forty percent of those with allergic rhinitis (inflammation of the nasal mucous membranes) and 12% of the general population have exercise-induced asthma.

Usually people with exercise-induced asthma experience shortness of breath after 10-15 minutes of exercise. If they work through it they get better and may be symptom-free for about four hours. The diagnosis is made by checking pulmonary function tests or a peak flow after exercise. A drop in peak flow of greater than 10% gives you a diagnosis of exercise-induced asthma.

The treatment has traditionally been to use an albuterol inhaler 20 minutes before exercise. For athletes involved in long tournaments or activities, however, this may require multiple dosing during the event. Another alternative has been cromolyn. Unfortunately, only 30% of people respond to cromolyn.

In a recent article in the New England Journal of Medicine, salmeterol (Serevent) was shown to maintain protection against exercise-induced asthma even after a month. There was a reduction in the decrease of FEV1 by around 10%. Salmeterol is a long lasting form of albuterol.

In that same issue of the New England Journal of Medicine, a new type of medication,   montelukast (Singulair), was shown to work well in exercise-induced asthma. The outcome that was examined was the area under the curve of the change in FEV1 in the first 60 minutes after exercise. Simply put, they were looking at how well the montelukast prevented a drop in lung function. There was a 47.4% reduction in the area under the curve. There was also a significant benefit in a lower maximal decrease in lung function and a shorter return of lung function to baseline. Tolerance to the medication (where it doesn’t work anymore) and rebound (where things are worse after stopping the medicine) was not seen. Seventy three percent of the patients felt that they were better. Side effects were no different than a placebo.  Montelukast can be used in children as young as five years old.

So for those of you who poop out with exercise or cough with exercise, see your doctor. If you have exercise-induced asthma, you may benefit from albuterol. If the albuterol doesn’t last long enough or if you develop tolerance to it, perhaps you might benefit from salmeterol or montelukast. If you’re just out of condition, keep at it, it eventually gets easier.