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In the field of respiratory disorders, asthma is a multifaceted condition with diverse symptoms. The two distinct types, exercise-induced asthma (EIA) and brittle asthma, present unique challenges and concerns for patients and healthcare providers alike.
In an interview with HT Lifestyle, Dr Rajesh Kumar Gupta, Additional Director, Pulmonology and Critical Care at Fortis Hospital, Greater Noida, explained, “Exercise-induced asthma (EIA) is a phenomenon in which physical exertion leads to asthma symptoms. Despite the misconception that exercise worsens asthma, regular physical activity is important for overall health. However, for people with EIA, an increase in breathing rate during exercise can lead to inflammation and constriction of the airways, resulting in symptoms such as coughing, wheezing, chest tightness, and shortness of breath. EIA usually occurs within 5-20 minutes of starting exercise and can persist for a varying period of time even after exercise.”
He added, “In contrast, brittle asthma is a severe and unstable form of asthma, characterised by unpredictable and sudden exacerbations that may not respond well to standard treatments. Unlike EIA, which is triggered by physical activity, brittle asthma episodes can be triggered by a variety of factors such as allergens, infections, stress or even exposure to cold air. Management of this subtype of asthma poses significant challenges and requires close monitoring and immediate intervention to prevent life-threatening complications.”
While both conditions fall under the category of asthma, their pathophysiology and clinical presentations differ significantly. Dr. Rajesh Kumar Gupta elaborates, “EIA primarily involves exercise-induced bronchoconstriction, induced by rapid inhalation of cold, dry air, leading to airway dehydration and subsequent inflammation. In contrast, brittle asthma is characterized by severe airway inflammation, hyper-sensitivity, and airway remodeling, often resulting in frequent exacerbations despite intensive treatment.”
Highlighting the variation in management approaches for EIA and brittle asthma as well, Dr Rajesh Kumar Gupta said, “For EIA, preventive measures such as warm-up exercises, proper hydration and use of bronchodilators before exercise are recommended to minimize symptoms. In contrast, brittle asthma requires a multidisciplinary approach that involves close collaboration between patients, pulmonologists and other specialists to formulate individualized treatment plans, often including high-dose inhaled corticosteroids, long-acting bronchodilators and biological therapies.”
He stressed, “While both exercise-induced asthma and brittle asthma share the common factor of respiratory distress, their etiology, clinical manifestations, and management strategies exhibit notable differences. Understanding these differences is paramount in providing personalized care and improving outcomes for individuals struggling with these complex respiratory conditions.”
Sharing his expertise on this, Dr. Sandeep Nair, Principal Director and HOD, Department of Chest and Respiratory Diseases, BLK Max Superspeciality Hospital said, “Exercise-induced asthma (EIA) is a condition in which the patient experiences an asthma attack, i.e. symptoms of coughing, wheezing and breathlessness, during any physical activity. The symptoms can range from mild to severe and can appear anytime during exercise. The symptoms can also persist after finishing the workout and usually start to improve after about 30-45 minutes of rest.”
According to him, one hypothesis of exercise triggering asthma symptoms is that one breathes through the mouth during exercise, due to which the air entering our lungs remains cool and dry as it passes through the nasal passage, where the skin is moist and there is hair to humidify the air and also filter out many other triggering agents. “Exercise-induced asthma is more commonly seen in cold and dry environments or when there is a high amount of allergens, including pollen, in the atmosphere. It can also worsen if a person is suffering from or recovering from a viral illness or if there is a sudden change in the outside temperature,” said Dr Sandeep Nair.
EIA is usually seen in sports involving vigorous exercise such as football, tennis or basketball or long-distance running like a marathon. “EIA can be prevented by taking proper medication, especially before engaging in any vigorous or strenuous exercise or playing in cold weather. It is also advisable to warm up for some time before starting physical exercise. One can also cover their face while exercising in a cold or polluted environment,” suggests Dr Sandeep Nair.
On the other hand, Dr. Sandeep Nair said, “Brittle asthma is a sudden acute episode of breathlessness that does not respond to the common bronchodilators given to the patient. Sometimes the symptoms are so severe that the person has to go to the hospital and get intravenous injections to recover. Though it is a rare disease, when it does occur, it is quite challenging to treat such patients. Patients may have a lot of wheezing or sometimes no chest pain at all. Patients may also suffer from hypoxia (low oxygen) and may even suffocate.”
He warned, “Usually the symptoms are triggered by some allergens like pollen or strong odors or food that the patient is allergic to. Even respiratory infections can worsen the symptoms. These patients should be treated promptly as these patients have low immunity and the condition deteriorates very fast. In most cases, the patients have to be hospitalized, where they are given bronchodilators and other supportive measures like oxygen. Sometimes patients have to be given ventilator support to deal with the condition.”
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