A few years ago, I decided to take up running after a prolonged post-college spell of inactivity. At first I was progressing smoothly. I shed a few pounds and started to feel a lot healthier. But then suddenly I noticed something strange: even on short jogs, my chest was starting to tighten. I felt like I was breathing through a straw, and every few minutes I launched into a series of hacking, mucous-spewing coughs to open my airways. Soon I was in the doctor’s office. The diagnosis: exercise-induced asthma (EIA), a growing problem among active adults.

Now, just shy of 30 years old, I’ve become a reluctant slave to a cocktail of lung and allergy medications, including Albuterol, Allegra, and Singulair. It’s a daily nuisance and a rather ironic price to pay for trying to be active and healthy. But I’ve recently learned that I’m not alone. According to the American Lung Association (ALA), 22.2 million Americans currently have different types of asthma. The chronic condition, which causes a restriction of the lung’s airways, accounted for 1.8 million emergency room visits in 2005.

“The rates of asthma have gone up continuously in this country,” says Claire Mullins of the ALA. “It’s strange because the rates of other diseases—cancer and heart disease—are being lowered, but with lung disease we’re seeing a steady increase.”

And it’s an athlete’s worst nightmare—an affliction that doesn’t discriminate between the developing novice and the most seasoned elite competitor.
In fact, some studies have suggested that it’s becoming more prevalent in endurance athletes. In a report released by the European Respiratory Society, a survey of 1,600 top athletes revealed that one in 10 experienced asthma or wheezing. The U.S. Olympic Committee found similar results after the 1996 Summer Games in Atlanta—one of the most air-polluted venues in decades. Out of 700 questioned participants, 117 admitted to suffering from asthma—more than 16 percent.

Jeff Wilbur has been an ultra-distance runner for more than a decade. But five years ago, the 49-year-old from Charlottesville, Va., suddenly started experiencing asthma symptoms. Today he still has trouble running: he feels like his lungs cannot keep up with his body, and he often becomes short of breath just 15 minutes into a race.

“I can’t seem to get back to my previous conditioning,” he says. “I’d never posted a DNF (Did Not Finish) before this started.”
Unfortunately, specific causes of EIA in adults are widely unknown. Research has shown that it is partially genetic predisposition (Wilbur’s mother developed asthma in her 50s), as well as a late-developing repercussion of childhood allergies. Air pollution—an epidemic in the Southeast—has also been proven to raise asthma rates and make attacks worse.

“Hundreds of studies have shown that people who have asthma will have flares with increased air pollution exposure,” says Clay Ballantine, an internal medicine doctor in Asheville, N.C., who focuses on pulmonary conditions. Asthmatics should avoid exercise during peak ozone times—typically late afternoon. Particularly in the summer, it’s best to run early in the morning or at sundown. Exercising on high-ozone days has been compared to smoking a full pack of cigarettes. Ballantine says it can be thought of as sunburn on your lungs: “It leaves them red, raw, inflamed, and hypersensitive, so any type of allergen or infection can trigger bronchospasms.”

Particulate pollution is harder to avoid, especially in the South, where there are a lot of coal-fired power plants. Runners should avoid hazy days with stagnant air and little wind.

Overall, exercise is still beneficial for asthmatics, but controlling the condition is crucial. Ignoring symptoms will only make them worse, because it allows the muscles that wrap around airways to get stronger and to tighten more in future attacks. “If you have asthma, you don’t want to underestimate it,” continues Ballantine. “If you get a really nasty attack, it could kill you. Fortunately asthma is something that can usually be easily managed.” Management has certainly been key for world class ultrarunner Anne Lundblad—last year’s winner of the USA 50 Mile Championships—who has been dealing with asthma since she was five years old. Her condition relates to seasonal allergies, which affects her running performance three or four times a year. She, like many others, also gets attacks in cold, dry air. She especially feels it during one of her favorite local races, the Mount Mitchell Challenge—a tough 40-mile slog in the Pisgah National Forest that she won last year.

“People said they heard me coming down the trail, because of my hacking and coughing,” she says. Lundblad is the ultimate example of an athlete who has been able to control asthma and achieve success. During long races, someone from her support crew always carries an Albuterol inhaler—a fast-acting bronchodilator that relaxes tightening airway muscles—in case of an emergency. If she has been experiencing regular symptoms, she will sometimes use it about 15-30 minutes before a run—another key tactic recommended by physicians.

“I am now able to tell when a flare up is likely to occur,” Lundblad says. “The key is preventive care.”

HOLD YOUR BREATH The South has six cities in the top 10 Asthma Capitals of 2008, including the number one place to lose your breath, Knoxville, Tenn. Knoxville has been named America’s asthma capital for the third time in the last five years.

Top 10 Asthma Capitals for 2008:
<br/>1. Knoxville, TN
<br/>2. Tulsa, OK
<br/>3. Milwaukee, WI
<br/>4. Atlanta, GA
<br/>5. Memphis, TN
<br/>6. Allentown, PA
<br/>7. Charlotte, NC
<br/>8. Greenville, SC
<br/>9. St. Louis, MO
<br/>10. Greensboro, NC