As a disease that can make the basic act of breathing a challenge, asthma can be a scary—and potentially fatal—condition for anyone to contend with in life. And it’s a health issue that affects a lot of people. In fact, more Americans than ever before, 25 million, have asthma, according to the Asthma and Allergy Foundation of America.

Living with asthma can be especially tricky for runners and may kick your huffing and puffing into the danger zone. But having asthma doesn’t mean you necessarily have to dial back your mileage or skip out on races. Just look to all the Olympians and pro athletes with asthma, like Paula Radcliffe, as proof. In fact, some research says about 8 percent of Olympians have asthma—the most common chronic health condition among this athletic crowd.

Living with asthma can be especially tricky for runners and may kick your huffing and puffing into the danger zone.

To help you navigate the condition, we talked with Sonali Bose, M.D., M.P.H., associate professor of medicine in pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City, for all the info on what happens in your body when you have asthma and how to manage it so you can keep up your activity levels. Whether you’ve had it all your life or have just recently developed symptoms and are curious about getting diagnosed, here’s everything you need to know and what it means for your running.

What is asthma?

Asthma is a chronic condition affecting the lungs and airways that carry oxygen to and from them. It’s usually characterised by inflammation of those airways, which can narrow when something triggers them (think smoke, an allergen, or exercise). “We think of airways in an asthmatic patient as being hypersensitive—what normally might not bother someone without asthma can cause the airways to be very twitchy in someone who has the disease,” says Dr. Bose.

An asthma attack is when symptoms worsen to the point that you’re having trouble breathing, wheezing, coughing, or feel significant tightness in your chest. It depends on the severity of someone’s condition, but an attack can cause serious complications or even be fatal if not managed quickly and properly.

What are the risk factors for asthma?

If one of your parents has asthma, you might too; genes do play a role, but they’re far from the only factor upping your chances of developing the disease, Dr. Bose says. Asthma is very closely tied to the environment, starting when you’re a foetus in your mother’s womb. Exposure to things like cigarette smoke, chemicals, and various microbes all play a role, as can poor air quality outside or in the home. People who have allergies or who had respiratory infections as a child may be at higher risk as well, she says.

Research also demonstrates the role the environment can play in asthma. For example, one older study published in 2014 found that children diagnosed with asthma by age 5 were more likely to have had early exposure to environmental factors like pesticides/herbicides and smoke or have been in daycare in their first four months of life. Meanwhile, a review published in 2020 points to several articles that have found that exposure to both indoor and outdoor pollution significantly ups your risk of getting asthma, especially for children.

“There’s also a significant amount of evidence linking traffic air pollution to asthma symptoms, asthma morbidity, and the development of chronic lung disease,” notes Dr. Bose. “Rural areas have their own problems with air quality, but if you live closer to areas that are more heavily trafficked, it can affect your asthma.”

What’s the difference between regular asthma and other types?

First of all, there’s no “regular” asthma. “There are many different types of the disease,” explains Dr. Bose. “People often lump them all together, but there are very different categories under the umbrella of asthma.” For instance, there’s a phenotype of asthma predominantly present in children that’s potentially more linked to allergies than other types of the condition. Other varieties of asthma can develop later in life, and some of these are linked to obesity.

Exercise-induced asthma is exactly as it sounds: Asthma that’s triggered by activity. But having this condition doesn’t mean that exercise is the only thing that can make breathing difficult—or even if that’s the only thing that sets off symptoms for you now, you may still develop sensitivity to other triggers in the future as well, says Dr. Bose.

What are the symptoms of asthma and how is it diagnosed?

The symptoms are mostly tied to breathing, such as shortness of breath with activity, tightness in your chest, coughing, or wheezing. But there are sneakier symptoms, too. “It can also be a sign that you should get checked out if you’re feeling like you’re not meeting your usual capacity or level when exercising,” says Dr. Bose. “This happens sometimes with elite athletes or people who train often—if their performance is off from their personal best, that can give a clue that they might have some limitations related to their airways.”

If you’re experiencing any of these symptoms, seek out a pulmonologist. Many asthma symptoms can present themselves with other conditions as well, such as allergies, so the doctor will do a variety of exams and potentially involve an allergist, too.

Your doctor will likely start with a breathing test to evaluate your ability to exhale. If you’re having trouble with this, it could reflect constriction or narrowing of the airways. They may also do a bronchoprovocation test, which simulates a condition that would cause narrowing of the airways and can determine whether the airways are hypersensitive. Allergy tests, via skin pricks or blood work, might also be necessary.

How is asthma treated?

Treatment varies greatly from person to person; your doctors will fine-tune your plan and may need to adjust it seasonally or from time to time if your symptoms change, says Dr. Bose. But generally, treatment involves an albuterol inhaler—a.k.a., a rescue inhaler. These are bronchodilators, meaning they open the airways, and you use them to relieve symptoms in the short term when you’re having an attack or before exercise.

Depending on your symptoms and the severity of your condition, you may also need a daily inhaler, oral medication, or other adjunct therapies, especially if allergies are one of the primary triggers of your symptoms. If your asthma is stable, you may not need to see your physicians regularly—but if you have severe symptoms, you should be evaluated and monitored closely by your pulmonologist, says Dr. Bose. If your symptoms are becoming more severe or frequent, that also means it’s time to talk with your doctor.

How does asthma affect running?

If you have asthma, make sure you talk with your doctors about whether running is right for you. But in many cases, you won’t have to stick to the sidelines just because of your condition—you’ll just need to make sure to have a plan in place.

Because asthma affects your airways and running is a cardiovascular activity, it can make racking up kilometres more challenging. Dr. Bose stresses that above all, it’s essential to be aware of your own symptoms and your surroundings (a path along a congested highway might aggravate your symptoms more than laps on a secluded track, for example), and to check in with your body during any outing. “If you’re doing an activity that’s bothering you, it might be wisest to stop the activity so it doesn’t get worse,” she says.

Runners can often keep up their miles, though, and even take on serious training if they stick to their medical plan personalised by their doctors. You’ll likely need to medicate before your workout to sidestep symptoms before they happen. Then always carry an inhaler with you—especially if, for instance, you’re training for an endurance race and are going to be running multiple hours.

Is running good or bad for someone with asthma?

“We encourage people to have the best respiratory fitness, and exercising is one way to support long-term lung health,” says Dr. Bose. In fact, there’s evidence that aerobic training and physical activity can help improve people’s lung health—especially if you have asthma. It might also help prevent the long-term decline of lung function that’s associated with asthma, says Dr. Bose.

The most important thing to remember: Before you sign up for your next race, make sure to speak with your doctors, stick to the medical strategies they set out for you, and always listen to your body.

READ MORE ON: asthma