Coughing After Running?


After hitting that 1-mile mark I found myself wheezing and struggling to take deep breaths. It felt different from regular exhaustion and not the same as that "out-of-shape" feeling that can crop up during a run. I stopped running, and walked back to the car. As I drove back home, I started coughing uncontrollably. My throat felt hoarse and I could feel pressure in my chest. What was going on?


Over the past four weeks, I'd felt good running. My running schedule included one tempo run, one long run, and one interval-training run. Sure, I felt pretty tired after all my runs, that's kind of what running does to you, but today was different. How so?


This particular morning I had decided to run JUST one mile, to see how fast I could do it. Not sprinting, just a good, fast pace, really pushing myself. If I could record how fast my "best" one-mile pace was, I could then set that pace as a goal for my longer runs, and try to build up to that speed over time.


What else was different? The temperature had dropped to freezing. My previous runs had been in temperatures in the 40s and 50s, sometimes in rain. Now, it was 30 degrees out, dry and cold.


Could fast running in cold weather have caused my wheezing and coughing?


Yes....


My heavy breathing in the cold, dry, air caused me to develop exercised induced bronchospasm (EIB) - what used to be called (EIA) exercised induced asthma (the terms have been used interchangeably, though treatments for EIB and EIA differ, and it is therefore important to distinguish the two).


EIB can happen to any exerciser, though it's more common among elite athletes, particularly cold weather endurance athletes such as Nordic skiiers. It commonly occurs during the conditions I put myself through that morning - an intense exercise session in cold weather, with fast oral breathing.


So what happens?

When frigid dry air rapidly hits the airway (which prefers some humidity), an exaggerated inflammatory response occurs. After the exercise bout has stopped, the airway begins to warm up again, resulting in increased blood flow. This warming releases other chemicals that can cause constriction of the airways (bronchospasm) as well as swelling,


Basically, once you've stopped exercising, the passageways constrict, causing wheezing and difficulties breathing, similar to an asthma attack.


In my case, I felt restrictions in my breathing during my run (but this is not that unusual when you're pushing yourself, and I didn't think much of it). It was really AFTER my run that the full-blown symptoms of EIB occured for me - chest tightness, wheezing, struggling to expel and inhale air. These symptoms were followed by a dry persistent cough, that lasted for about an hour or so after I had stopped exercising. For the rest of the day, I felt some "soreness" when I was breathing, similar to when recovering from bronchitis (if you've ever experienced that). By the next morning, I had no symptoms at all.


Here's some nerdier language to describe the causes of EIB:


"Our current understanding of the pathophysiology of EIB is that hyperventilation during exercise causes a loss of heat and a drying of the airways, leading to dehydration of the airway cells and increased intracellular osmolarity. The osmotic gradient that is created stimulates the release of inflammatory mediators, including histamines, cytokines, and leukotrienes, among others. These mediators, along with airway dehydration, cause an exaggerated response that results in EIB.

Once the exercise is completed, airway cooling reverses as smaller bronchial vessels warm, creating a reactive hyperemia. This warming establishes another osmotic gradient that releases mediators, causing bronchospasm and airway edema, which can further contribute to EIB."

Source: Sports Health, Exercise-Induced Bronchospasm

Marc A. Molis, MD FAAFP and Whitney E. Molis MD, FAAAAI, FACAAI, FAAP, 2010 Jul; 2(4): 311–317.


Do I need to see a doctor if I experience EIB?

It is always a good idea to consult with your Primary Care Physician if you have any concerns about your breathing, particularly during these current pandemic times. EIB symptoms can also mimic other serious health issues, such as sudden heart attack, and it is, of course, important to rule these conditions out.


Cold weather running can induce EIB.


How do I avoid EIB?

Once you're sure you have a clean bill of health, you can take the following measures to avoid EIB when running in cold weather.


- Don't try to set a personal record during the coldest day of the year! Respect harsh weather conditions, and go for a more relaxed run.

- Warm up gently for 10-15 minutes, before going on the run.

- Wear a face-mask or scarf over your mouth to moisten the air as you breathe.

- Try to breathe somewhat from your nose when you can during your run (the nasal passageways are better at warming and moisturizing the cold air)

- If you continue to experience symptoms when you go out to exercise, ask your doctor about pharmacological management


EIB does not have to hold you back during winter running. Talk to a physical therapist or a physician if you need guidance in how to manage your personal experience with EIB!


- Katarina Erlandsson, PT DPT


About:

Katarina PT offers in-home physical therapy services in Madison, NJ, and surrounding areas.

RUNNERS | ATHLETES | EXERCISE ENTHUSIASTS


Contact: 973.845.8972

info@katarinapt.com