Exercise Induced Asthma and Brittle Asthma: Differences, coping with symptoms, prevention tips

In the realm of respiratory disorders, asthma stands as a multifaceted condition with diverse manifestations. Two distinct types, exercise-induced asthma (EIA) and brittle asthma, present unique challenges and considerations 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 in Greater Noida, explained, “Exercise-Induced Asthma (EIA) is a phenomenon characterised by the onset of asthma symptoms triggered by physical exertion. Despite the misconception that exercise worsens asthma, regular physical activity is crucial for overall health. However, for those with EIA, the increased breathing rate during exercise can lead to airway inflammation and constriction, resulting in symptoms such as coughing, wheezing, chest tightness, and shortness of breath. EIA typically occurs within 5-20 minutes of beginning exercise and may persist for a variable duration post-exercise.”

He added, “In contrast, Brittle Asthma represents 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 provoked by various factors such as allergens, infections, stress, or even exposure to cold air. This subtype of asthma poses significant challenges in management and requires close monitoring and prompt intervention to prevent life-threatening complications.”

While both conditions fall under the umbrella of asthma, their pathophysiology and clinical presentations differ substantially. Dr Rajesh Kumar Gupta elaborated, “EIA primarily involves exercise-induced bronchoconstriction, driven by the rapid inhalation of cool, dry air leading to airway dehydration and subsequent inflammation. In contrast, brittle asthma is characterized by severe airway inflammation, hyperresponsiveness, and airway remodeling, often resulting in recurrent exacerbations despite intensive therapy.”

Highlighting that the management approaches for EIA and brittle asthma also diverge, Dr Rajesh Kumar Gupta said, “For EIA, preventive measures such as warm-up exercises, proper hydration, and pre-exercise bronchodilator use are recommended to mitigate symptoms. In contrast, brittle asthma necessitates a multidisciplinary approach involving close collaboration between patients, pulmonologists, and other specialists to tailor individualized treatment plans, often incorporating high-dose inhaled corticosteroids, long-acting bronchodilators, and biologic therapies.”

He asserted, “While both exercise-induced asthma and brittle asthma share the common denominator of respiratory distress, their etiology, clinical manifestations, and management strategies exhibit notable distinctions. Understanding these differences is paramount in delivering personalized care and improving outcomes for individuals grappling with these complex respiratory conditions.”

Bringing his expertise to the same, Dr Sandeep Nayar, Principal Director and HOD – Chest and Respiratory Diseases at BLK Max Super Speciality Hospital, shared “Exercise Induced Asthma (EIA) is a condition in which the patient has an attack of asthma i.e. symptoms of coughing, wheezing & shortness of breath during any physical activity. Symptoms may range from mild to severe and can appear anytime during exercise. Symptoms may even appear after one has finished a workout and usually start to improve after about 30-45 minutes of rest.”

According to him, one of the hypothesis for exercise inducing asthmatic symptoms is that during exercise one tend to breathe through mouth due to which air entering our lungs remains cold and dry as it bypass nasal pathway where the skin is moist and has hair to moisturise the air and also filters many other triggering agents. Dr Sandeep Nayar said, “Exercise induced asthma is more common seen in cold and dry environment or when the amount of allergens including pollens are high in atmosphere. It may worsen if one is suffering or recovering from viral illness or during sudden change of temperature outside.”

EIA is more commonly seen in sports requiring vigorous exercise like soccer, tennis or basketball or long distance running like marathon. Dr Sandeep Nayar suggested, “EIA may be prevented by taking appropriate medication specially before indulging in any vigorous or strenuous exercise or playing in cold climate. It is also advisable to warm up for sometime before starting physical exercise. One may even cover his/her face while exercising in cold or polluted atmosphere.”

On the other hand, Dr Sandeep Nayar revealed, “Brittle asthma is characterised by sudden acute attacks of breathlessness where patient fail to respond to normal bronchodilators which he is being prescribed. Sometimes the symptoms are so bad that one has to rush to the hospital and has to be administered intravenous injections for recovery. Though it is a rare entity but when occurs, it is quite challenging to treat such patients. Patients may have extensive wheezing or sometimes present with absolutely silent chest. Patients may even have hypoxia (low oxygen) and may even present with choking.”

He cautioned, “The symptoms are usually triggered by some allergens like pollen or strong smell or food which patient is allergic to. Even respiratory infections can worsen the symptoms. The treatment has to be abrupt as these patients have low reserve and condition deteriorate very fast. Most of the time patients have to be managed at hospital where bronchodilators and other supportive measure like oxygen has to be administered. Sometimes patients have to be given ventilator support to tide over the situation.”