• If exercise-induced asthma is a symptom of poor asthma control, manage it as uncontrolled asthma.
• If a person has otherwise well-controlled asthma, but finds exercise-induced asthma to be a problem:
• Advise short-burst activities, exercising in humid environments, and breathing through the nose to avoid hyperventilation.
• Prescribe use of a short-acting beta2-agonist 10–15 minutes before the start of exercise and after 2 hours of prolonged exercise, or after exercise has finished.
• If exercise-induced symptoms persist despite use of a short-acting beta₂-agonist (adequate dosage with good concordance):
• Consider starting an inhaled corticosteroid.
• If the individual is still symptomatic despite using an inhaled corticosteroid, consider prescribing a long-acting beta2-agonist or leukotriene receptor antagonist for regular use.
• Other options, such as theophylline, sodium cromoglicate, or nedocromil sodium, and oral modified-release beta2-agonist (adults only) can be used but are less effective in exercise-induced asthma.
• If the person does not respond to treatment and exercise-induced asthma is still problematic (especially in athletes), consider referral to a respiratory specialist.

In depth

• Advise overweight people that a healthy diet and regular exercise will help with weight reduction and improve asthma control:
• Advise people (if possible) to take 30 minutes of exercise to increase their heart rate at least five times weekly. For more information on weight loss, see the CKS topic on Obesity.

In depth

• Advise smokers with asthma to stop smoking and provide them with the appropriate help. For more information, see the CKS topic on Smoking cessation.
• Advise people with asthma to, as far as possible, avoid exposure to tobacco smoke. For parents who smoke and have a child with asthma, this means either stopping smoking (the best option), or not smoking in the same room as the child (or, preferably, not smoking in the house).

In depth

• Advise an influenza and a pneumococcal vaccination if asthma is severe and requires hospital admission or frequent use of corticosteroids.
• For more information, see the CKS topics on:
• Immunizations - seasonal influenza.
• Immunizations - pneumococcal.

In depth

• Advise to report symptoms of conditions that could worsen asthma, such as rhinitis, sinusitis, gastro-oesophageal reflux disease, and sleep apnoea.

In depth

• Advise to avoid (if possible) known trigger factors, especially at times when asthma is poorly controlled.
• Advise all adults to report promptly any worsening asthma control during work.

In depth

Exercise-induced symptoms are often a sign of poor asthma control. If this is thought to be the case, see Scenario: Uncontrolled asthma on current treatment.