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Asthma

Delayed Inflammation

03/11/2010

Question:

I have been DX with probable asthma (19/20 on the final stage of the methocholine challenge). My problem is that when I exercise today I will be fine - but 24-48 hours later I have bronchitis type of symptoms in the chest but no fever or sputum. This is consistent. If I then try to exercise or exert myself I end up very short of breath - not able to speak in full sentences - SOBOE. Using Ventolin as a rescue does nothing.

I did have sometime of chemical/smoke/irritant exposure about 6 months before all of this started. It has been going on for over a year. I currently take Symbicort 200 2x twice a day.

No one can explain the delayed reaction that I am having. It does not appear to be any form of anxiety or psychological in its basis. Rather it is physiological.

Any ideas or suggestions?

Thank you in advance.

Answer:

Exercise is one of the most common triggers for bronchospasm in people with chronic asthma. There are also people who only have bronchospasm when they exercise.  These people do not have bronchospasm at any other time and thus do not have chronic asthma.

 

In both cases, the primary treatment is use of a short acting beta agonist (such as ventolin) prior to exercise and if that fails to add on an inhaled corticosteroid or leukotriene modifier.

 

When a person has shortness of breath with exercise, there are several possible etiologies. Exercise induced asthma is one of them and other possibilities include exercise induced vocal cord dysfunction, exercise induced GERD, or a cardiac problem most often an abnormal heart rate with exercise. When usual treatment with a short acting beta agonist and an inhaled steroid do not help the symptoms at all, then it is less likely the symptoms are due to exercise induced asthma. You might then consider asking for a referral to a center/clinic with experience in evaluating exercise-induced shortness of breath to determine if other testing is required.

For more information:

Go to the Asthma health topic, where you can:

Response by:

John G Mastronarde, MD John G Mastronarde, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University