EIA in Elite Footballers

New research from the University of Kent finds that 3 out of 10 elite footballers may have undetected lung and airway problems, such as EIA (exercise-induced asthma).

Lung health in footballers

Lead researcher, Ana Jackson, is suggesting that a programme for lung health screening needs implementing. She came to this conclusion after assessing the airway health in elite footballers from top clubs in England. While undergoing pre-season fitness and medical screening a high-rate of players were found to have previously undiagnosed exercise-induced asthma (EIA).

EIA in footballers

The players identified as having EIA were experiencing breathing problems. This is because EIA is a narrowing of the airways in the lungs. And it is strenuous exercise that triggers it. Those players experiencing EIA will complain of shortness of breath, wheezing or coughing. And these symptoms can come on both during, and after exercise.

The players experiencing EIA found that their symptoms reduced after being treated with appropriate medication. And, over time, their lung function was found to improve too. Not only that, but their aerobic fitness and performance also improved.

Health screening at clubs

Football clubs will screen for heart problems, and this research now calls for lung health screening too. This will help detect and identify any respiratory problems players may be experiencing. Players may not realise that coughing or wheezing are symptoms of deeper breathing problems. As a result, players are being wrongly dismissed as being too unfit to play. In fact, they may actually be suffering from EIA.

Tailoring treatment to those affected

Assessing a footballers’ breathing and lung function is paramount. Not only will it help to detect a breathing problem, but it will help tailor treatment. And treatment for improving players’ breathing strength and stamina will also improve their performance. So breathing training will, in fact, be beneficial for all players as part of their training regimen.

EIA in other sports

Exercise-induced asthma is also experienced by elite athletes in other sports. And it is as a result of the high intensity at which they exercise, and the long duration of high-intensity exercise. This type of endurance exercise pushes their breathing rates to their highest limit.

Endurance sports, such as long-distance running, cross-country skiing and cycling are the most likely activities to cause problems for people with exercise-induced asthma. And now football will too.

Breathing muscle training improves performance

Inspiratory muscle training (IMT) is a strength training protocol for the breathing muscles. It is scientifically proven to improve breathing muscle strength and stamina and reduce breathing fatigue. And because it is drug-free, it has no drug interactions or side-effects. It is also easy-to-use and time efficient. In fact, players need only perform 30 breaths twice a day to feel the benefits after just 4-weeks.

Benefits to players of IMT

IMT is an intervention in numerous scientific research and clinical trials. This is because strengthening the breathing muscles can benefit everyone.

In scientific tests and studies IMT:

TUEs, asthma and athletes

Therapeutic Use Exemptions (TUEs) allow an athlete to take medication on WADA’s Prohibited List when competing.

TUEs in the news

TUEs have become a hot topic as a result of the cyber attack leaking WADA data on 29 athletes. It was just after the Rio Olympics. Selected athletes’ medical records are being hacked into by a group from Russia calling themselves Fancy Bears. They were hacking into the World Anti-Doping Agency’s Anti-Doping Administration and Management System (Adams) database. This stores athletes laboratory results, anti-doping rule violations and therapeutic use exemption (TUE) authorisations.

What’s the big deal about TUEs

It is this data hacking into TUEs that is opening our eyes to the number of elite athletes being given permission to use them. It is raising doubt about their use in ‘fair’ competition. People are asking if they are really needed, and if not, are they providing athletes with a performance edge? In fact Dr Ross Tucker refers to the prevalence of corticosteroid use. Athletes will be given this if they experience breathing problems. It is however also considered to be performance-enhancing.

Breathing is an issue in many athletes

The most common breathing condition among elite athletes in endurance sports is asthma. In fact according to Asthma UK 25% of the 2012 Team GB athletics squad suffer from exercise-induced asthma.

Why do so many elite athletes have exercise-induced asthma?

Vigorous exercise and endurance sports such as long-distance running, cross-country skiing and cycling cause problems for people with exercise-induced asthma. This is because it makes them breathe much faster which in turn affects airflow. Dr John Dickinson says such athletes “have an asthma response to doing high-intensity exercise.” He continues, “It’s not necessarily the exercise that’s the problem, but rather the volume of air that they breathe and the amount of time that they stay at this level for.” Dr John Dickinson is a world renowned expert on asthma in sport and head of the respiratory clinic at Kent’s School of Sport and Exercise Science.

TUEs for athletes with asthma

Symptoms of exercise-induced asthma include coughing, wheezing, chest-tightness and difficulty in breathing. Because of this inhaled treatment is allowed. This is only allowed however where asthma is documented and dispensation has been granted when needed. By contrast systemic β2-agonist intake is strictly prohibited.

POWERbreathe IMT can help strengthen breathing

Most importantly for athletes with asthma, POWERbreathe IMT is drug-free. It has no side-effects or drug interactions. POWERbreathe is an Inspiratory Muscle Training device. This means it trains the inspiratory muscles only; the muscles used to breathe in. It’s these muscles that work the hardest, your diaphragm and intercostal muscles.

How POWERbreathe IMT works

You simply breathe in through the device. As you breathe in you’ll feel a resistance to your in-breath. This is the resistance working. As you breathe in against the resistance you are exercising your breathing muscles. Exercising your breathing muscles in this way makes them stronger. It strengthens your breathing muscles just like resistance training strengthens your other muscles. And the more you train the stronger your breathing muscles become. Then you can simply increase the resistance, just as you would in other training, so that you continue to improve.

Scientifically proven training

POWERbreathe IMT is the breathing training device that both sports scientists and medical professionals are using in tests. And it is sports scientists who found the most effective training protocol. Their findings showed that just 30 breaths twice a day is the most effective. They were also to discover that just as other muscles experience the ‘use it or lose it’ phenomenon, so do the breathing muscles.

The benefits of POWERbreathe IMT

POWERbreathe IMT will strengthen your breathing muscles, improve breathing stamina and reduce breathing fatigue. And it will improve sports performance and time trial performance. In fact, POWERbreathe IMT is the device of choice in many scientific studies into its benefits for sports and fitness.

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Brentford and Republic of Ireland midfielder suffers EIA

POWERbreathe Inspiratory Muscle Training (IMT) could help Brentford and Republic of Ireland midfielder Alan Judge who’s recently been reprimanded by the Football Association after breaching doping regulations for consuming higher levels of his asthma medication than is permitted. Judge is one of many sports people that suffer with exercise-induced asthma (EIA) and uses an inhaler. Endurance sports, such as long-distance running, cross-country skiing and cycling are the most likely activities to cause problems for people with exercise-induced asthma. A Case Report published in the British Journal of Sports Medicine looked at Inspiratory Muscle Training: a simple cost-effective treatment for inspiratory stridor, which described the support given to a British elite athlete in the build-up to the 2004 Olympic Games in Athens. Complaining of breathing symptoms during high intensity training which resulted in a reduction in performance and premature cessation of training, the athlete undertook a eucapnic voluntary hyperpnoea challenge to test for her exercise-induced asthma (EIA). Following consultation with a sports physician and physiologist, the athlete was diagnosed with inspiratory stridor and an inspiratory muscle training (IMT) intervention was implemented. The IMT intervention required 30 loaded breaths twice daily using POWERbreathe five times per week for 11 weeks. The athlete reported a precipitous fall in symptoms and was able to complete high intensity training without symptoms. If you suffer from exercise induced asthma (EIA) then breathing training with POWERbreathe could help you train in a safe and productive manner and because it is drug-free won’t incur scrutiny from the World Anti-Doping Agency (WADA).

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Exercise-Induced Asthma – and POWERbreathe

Pip Windsor from Phsyio2Breathe is an expert with over 20 years’ experience in the treatment of Breathing Pattern Disorders (BPD) and Asthma Education and is an MDT Certified BradCliff Method® Practitioner (a structured research-based physiotherapy assessment and treatment programme for breathing pattern disorders).

Pip has written this article about Exercise-Induced Asthma (EIA) for Evolved Physiotherapy & Performance, a clinic specialising in injury recovery, strength and conditioning, sports psychology and endurance coaching.

Pip begins by asking ‘what is asthma’ and suggests a few solutions that could help; one of which is strengthening the breathing muscles with POWERbreathe to make them more efficient and less prone to fatigue. Pip then offers 3 tips on how best to breathe.

Read the full article Exercise-Induced Asthma >

What causes exercise-induced asthma?

The reason why asthma symptoms may be brought on during exercise has not been completely established but it is thought that because breathing becomes heavy and we breathe faster when we exercise, the linings of our airways narrow and dry out. Also weather conditions and allergies, such as an allergy to pollen, can also trigger asthma-like symptoms when exercising.

Recognising exericse-induced asthma (EIA)

Diagnosis is often made after symptoms, such as wheezing and a tight chest, are experienced during exercise, but this can result in either over-diagnosis, where athletes report symptoms but DO NOT have narrowing of the airways, or under-diagnosis where athletes who’re asymptomatic (showing no symptoms) DO have narrowing of the airways which affects their performance.

The scenarios above are supported in studies where elite athletes have been screened and shown to have EIA, such as reported by British Olympic Teams in the 2012 Olympics where it found that 25% of Team GB suffers from exercise-induced asthma. And at the 1996 Olympic games 20% of athletes reported asthma upon exercising.

Why screen for EIA?

The main reason is because exercise-induced asthma may be detrimental to an athlete’s performance, as it’s already been shown to reduce exercise capacity and running speed in colder environments which will not only affect an athlete during training but also during competition.

Treatment of EIA

Both pharmacological and non pharmacological therapies are currently successfully used to treat EIA, and studies have also highlighted the benefits of adjunctive intervention. POWERbreathe Inspiratory Muscle Training can be used as an adjunctive intervention, not only for daily training, but also as a respiratory warm-up prior to exercise.

Read more about Respiratory Disorders in endurance athletes in our blog.

And here’s an interesting article that looks at Pollen and Exercise Induced Asthma >

Respiratory disorders in endurance athletes

Open Access article published in the Journal of Sports Medicine April 2nd 2014.


Respiratory disorders in endurance athletes – how much do they really have to endure?


“Respiratory disorders are often a cause of morbidity in top level endurance athletes, more often compromising their performance and rarely being a cause of death… Both bronchospasm and the onset of interstitial edema induced by exercise cannot be considered pathological per se, but are more likely findings that occur in several healthy subjects once physical exhaustion during exertion has been reached. Consequently, we get a vision of the respiratory system perfectly tailored to meet the body’s metabolic demands under normal conditions but which is limited when challenged by strenuous exercise, in particular when it happens in an unfavorable environment.”

The prevalence and incidence of exercise-induced respiratory disorders in athletes

“In sports requiring strenuous endurance training, athletes are obliged to inspire large volumes of air, and for this reason an increased risk of developing EIA/EIB (Exercise-Induced Asthma/Exercise-Induced Bronchoconstriction) may be expected. This risk is further increased if athletes are exposed to cold air.”

Conclusion and future direction

“With the state of current knowledge, cardiac problems are not the only cause of morbidity and mortality among endurance athletes. For this reason, the above mentioned meaningful evidence of respiratory disorders in endurance athletes deserves to be widespread knowledge both in the scientific and in the athletic international community. As a matter of fact, paying attention to the concept that the respiratory system may show a pathophysiological limitation to endurance performance and sometimes be a cause of illness or even death is definitely the first step…”

…“In conclusion, taking up the question of the title of this report, we can say that every endurance athlete has their own limit in endurance training that once passed will produce all the possible respiratory disorders previously described. The question is precisely to understand if there is a limit in terms of intensity and/or in terms of duration in years to endurance training, before respiratory disorders can appear, and if we can apply any preventive strategies. To be an endurance champion, this inevitably means accepting all the labors of strong training but also enduring all possible health problems caused by the same.”

View the full article.

View list of published research that used POWERbreathe as the IMT intervention of choice in POWERbreathe in Research.

Find more published research on our Inspiratory Muscle Training Research blog.

Quarter of Team GB Suffer Exercise-Induced Asthma (EIA)

It’s 2012 and the year of the London Olympics. The London Evening Standard reports that 25% of Team GB is suffering from exercise-induced asthma (EIA). Such athletes include swimmers Rebecca Adlington and Jo Jackson, as well as, Tour de France champion Bradley Wiggins. Also, marathon runner Paula Radcliffe and footballer Craig Bellamy. And defending Olympic rowing champions Pete Reed and Tom James experience symptoms of EIA too.

Can asthma sufferers exercise?

Well, yes. Asthma UK recommend people with asthma participate in exercise. This is because it improves lung function and can help you manage your symptoms.

EIA is high among elite athletes

It seems endurance sports, such as long-distance running, cross-country skiing and cycling are the most likely activities to cause problems for people with exercise-induced asthma and inspiratory stridor. A high-pitched, wheezing sound when breathing-in is indicative of inspiratory stridor.

A case study of inspiratory stridor

A Case Report in the British Journal of Sports Medicine looks at Inspiratory Muscle Training: a simple cost-effective treatment for inspiratory stridor. It describes the support given to a British elite athlete in the build-up to the 2004 Olympic Games in Athens.

The athlete had been complaining of breathing symptoms during high intensity training. Because of this they couldn’t manage to complete their training sessions. Consequently, they experienced a reduction in performance. The athlete then undertook a gold-standard test for diagnosing exercise-induced asthma (EIA). The EVH challenge is a 6-min test during which the athlete breathes a cold, dry gas at very high ventilation rates. After the test their airway function is compared against normal resting airway function.

Following consultation with a sports physician and physiologist, a diagnosis of inspiratory stridor was given. The advice was to implement a course of inspiratory muscle training (IMT).

Inspiratory Muscle Training (IMT) as a treatment

The course of IMT used a POWERbreathe device and required 30 loaded breaths, twice daily, five times per week for 11 weeks.

The athlete reported a sudden fall in symptoms and was able to complete high intensity training without symptoms. This case shows that IMT is a suitable cost-effective intervention for athletes who present with inspiratory stridor.