Nose, Sinus Should Be Clear
The nose and sinus (upper airway) should be as clear as possible when exercising, so that nasal breathing can take place. This is important because the nasal passages contain a natural filtering and humidifying system. This system will help keep the air at proper temperature and humidity. In addition, this nasal filtering system will help to keep out pollutants, irritants and allergens.

If a person breathes through the mouth, this filtering and humidifying system is bypassed. Mouth breathing can introduce irritants to the bronchial tubes and lungs and the exercise program will be less effective.

It may be necessary or helpful for the allergic patient to use a medication that will keep the airways open, such as an antihistamine, decongestant, nasal cromolyn sodium, or a nasal steroid spray. (Check with your doctor, as many of these are prescription medications.) The asthmatic patient may need to use medication for his bronchial tubes if exercise causes symptoms of chest tightness, cough, wheezing or shortness of breath. This can commonly occur in patients with asthma, chronic bronchitis or chronic obstructive pulmonary disease.

In addition to immediate bronchial constriction and wheezing, exercise has recently been shown to cause delayed reactions 6-12 hours after the initial exercise has been performed.

Some common delayed symptoms include chest tightness, cough and shortness of breath. Patients who develop such problems can often prevent these symptoms by taking medication prior to exercising. An inhaler, such as cromolyn sodium, taken 5-10 minutes before exercise, is one type of medication that can be used.

   Use of Medications
Sometimes theophylline or other bronchodilator tablets are recommended before exercise. The type of medication used depends on the frequency and duration of physical activity, how often exercising is done throughout the day, and the practicality of taking medication before exercise. A physician should be consulted on the best medication to use before exercise.

After the medication decision has been made, the choice of the exercise activity and the location are very important. If you have allergies, vigorous exercising should obviously not be done near fields full of grasses and weeds. It may be more appropriate to exercise indoors at certain times of the year. If exercise is done outdoors, it should be in areas where there are not large concentrations of allergens (pollens, dust, mold, etc.). If allergens cannot be avoided, certain preventative methods, such as medication taken before exercise and or wearing of a mask, may be indicated.

Exercising should also be avoided in areas where there are large amounts of chemical irritants. For example, jogging and other vigorous sports should not be done near heavy traffic areas where there is a large amount of exhaust from vehicles, or near factories that emit large amounts of pollutants in the atmosphere. Indoor areas where there are noxious or irritating odors should also be avoided.

    Running and Bronchial Spasms
The allergic or asthmatic individual should consider what form of exercise they plan to do. Continuous running, for example, most commonly causes bronchial constriction and spasm to those with respiratory problems, while swimming poses the least amount of respiratory irritation. Exercise that has stop-and-go activity tends to cause less bronchial constriction than an exercise using continuous motion. Weather conditions should also be considered when exercising. Cold and dry or very dry weather can be quite irritating to the bronchial tubes. Special precautions should be taken by those individuals who have severe allergies to stinging insects (such as bee, wasp, yellow-jacket, etc.). If exercising is done outdoors, injectable epinephrine must be kept on hand. Another person should also be near to assist in an emergency. Individuals with bee-sting allergy should avoid wearing bright-colored clothing or strong perfumes or lotions that may attract stinging insects and increase the risk of being stung. Areas where stinging insects tend to habitate should always be avoided. These include flower beds and flowering fields, bodies of water and areas near garbage.

    Carry Injectable Epinephrine
The most care when exercising should be taken by individuals who develop hives, swelling or anaphylaxis. (Anaphylaxis is the most severe form of an allergic reaction and can be life-threatening.) Patients must carry injectable epinephrine with them, should never exercise alone and should not exercise or jog in remote areas where medical help is not nearby. These individuals may also find it necessary to take antihistamines or other medication before they exercise.

All the above factors should be taken into consideration before and exercise program is begun or before any type of physical activity is planned. These suggestions and precautions are not meant to discourage exercise, but to help in choosing suitable activities, taking into account different medical conditions and circumstances. Remember, patients with bronchial asthma have even participated (and won medals) in the Olympics. Exercise programs can be quite vigorous and helpful if undertaken with care and a physicians guidance.