Your doctor may prescribe drugs to take shortly before exercise or to take daily for long-term control.
Your doctor may prescribe a drug that you take before exercise to minimize or prevent exercise-induced bronchoconstriction. Talk to your doctor about how much time you need between taking the drug and exercising. Drugs in this group include the following:
- Short-acting beta agonists (SABAs) are inhaled drugs that help open airways. These are the most commonly used and generally most effective pre-exercise medications. Daily use of a SABA is not recommended, however, because you may develop a tolerance to its effect. These drugs include albuterol (ProAir HFA, Proventil HFA, Ventolin HFA), levalbuterol (Xopenex HFA) and pirbuterol (Maxair).
- Ipratropium (Atrovent HFA) is an inhaled medication that relaxes the airways and may be effective for some people. A generic version of ipratropium also can be taken with a nebulizer.
Long-term control medications
Your doctor may prescribe a long-term control drug in addition to daily use of a pre-exercise medication, to manage underlying chronic asthma or to manage symptoms when pre-exercise treatment alone isn't effective. These medications, usually taken daily, include the following:
- Inhaled corticosteroids help suppress inflammation in your airways. You may need to take the drug two to four weeks before they will have maximum benefit. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler) and beclomethasone (Qvar).
- Combination inhalers contain a corticosteroid and a long-acting beta agonist (LABA), a drug that relaxes airways. While these inhalers are prescribed for long-term control, your doctor may recommend use prior to exercise. Combination inhalers include fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), and mometasone and formoterol (Dulera).
- Leukotriene modifiers are oral medications that may block inflammatory activity for some people. These drugs may be used daily or as a preventive treatment before exercise if taken at least two hours in advance. Examples include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). Potential side effects of leukotriene modifiers include behavior and mood changes and suicidal thoughts. Talk to your doctor if you experience these signs or symptoms.
Don't rely only on quick-relief medications
You can also use pre-exercise drugs as a quick-relief treatment for symptoms. However, you shouldn't need to use your pre-exercise inhaler more often than your doctor recommends.
Keep a record of how many puffs you use each week, how often you use your pre-exercise inhaler for prevention and how often you use it to treat symptoms. If you use it daily or you frequently use it for symptom relief, your doctor may adjust your long-term control medication.
Oct. 25, 2014
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- Parsons JP, et al. An official American Thoracic Society clinical practice guideline: Exercise-induced bronchoconstriction. American Journal of Respiratory and Critical Care Medicine. 2013;187:1016.
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- Updated information on leukotriene inhibitors: Montelukast (marketed as Singulair), zafirlukast (marketed as Accolate), and zileuton (marketed as Zyflo and Zyflo CR). http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm165489.htm. Accessed Oct. 1, 2014.
- Stickland MK, et al. Effect of warm-up exercise on exercise-induced bronchoconstriction. Medicine and Science in Sports and Exercise. 2012;44:383.
- Asthma action plans: Help patients take control. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health-pro/resources/lung/naci/discover/action-plans.htm. Accessed Sept. 12, 2014.
- Mickleborough TD, et al. Exercise-induced asthma: Nutritional management. Current Sports Medicine Reports. 2011;10:197.
- Li JTC (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 22, 2014.
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