A new recommendation for inhaler use may improve both asthma control and exercise performance.
Individuals with asthma often rely on an inhaler either to reduce cough and chest tightness or to prevent symptoms before exercise, increasing performance.
RELATED TOPIC: Does Your Child Have Asthma?
What exactly is asthma?
There are 2 main changes in the lungs with asthma:
- Narrowing of medium and smaller airways (called bronchospasm). Think of toilet paper roll going down to the size of a straw.
- Swelling and inflammation of those medium and smaller airways. Think of Jell-O in those already narrowed airways.
The cough from asthma attempts to re-open airways and clear that inflammation.
Most inhalers prescribed for this purpose contain albuterol, a medication that opens medium and small airways. Albuterol is classified as a Short-Acting Beta Agonist (SABA), with effects lasting 4–6 hours. There are also “cousins” of albuterol—Long-Acting Beta Agonists (LABA)—that can last up to 12 hours.
Athletes with asthma commonly carry their inhaler in a bag or backpack and use it before practice or games. This pre-performance routine often helps reduce fatigue, chest tightness, and cough during exercise.
Learn More About Asthma and Exercise:
Would It Be SMART to Change the Use of Inhalers?
Guidelines issued by the Global Initiative for Asthma in 2025 (GINA) introduced a SMART approach for both prevention and reduction of asthma symptoms.
SMART stands for Single Maintenance and Reliever Therapy, which recommends the use of one inhaler that acts to both open airways and reduce inflammation.
This concept increases the use of Inhaled Corticosteroids (ICS) to address the airway swelling.
These inhaled corticosteroids are different from muscle-building steroids and generally do not trigger abnormalities with drug testing. One potential concern is that long-term ICS use may affect height growth, but poorly controlled asthma can also reduce eventual height.
Instead of using albuterol (SABA) before every workout, the GINA 2025 guidelines recommend using a combination of the ICS with a longer-acting airway medication (LABA inhaler). This combination inhaler can be used both for daily prevention and “as needed” during flare-ups, including exercise, illness, or environmental triggers (like cold air, smog, or wildfire smoke).
The goal: reduce both airway narrowing and swelling, improving exercise performance while lowering the risk of severe flares that could require higher dose medication use, emergent medical visits, and hospitalizations.
How Can Athletes Know What’s SMART For Them to Ensure PEAK Performance?
Does this mean everyone should toss their albuterol inhaler? Not necessarily. The best decision comes from the best data.
One tool I recommend for athletes is a Peak Flow Meter – a portable device that helps assess asthma control and airway function during exercise and sport performance by measuring airflow from your lungs.
Unlike other devices that are usually used in clinic settings, a Peak Flow Meter is portable and can be used on fields, dance floors, courts, and rinks- giving a truer measure of how exercise and sport environments affect asthma control.
Peak flow meters are inexpensive, handheld, and can be used anywhere—on the field, court, rink, or dance floor. They provide real-time feedback as a truer measure of how exercise and sport environments affect asthma control.
Here’s how I suggest athletes use them:
- Establish a baseline: Do 3 trials every morning (blow as hard as possible) and record all values. Do this until a baseline is established.
- Test during exercise: Do 3 trials at the most intense point of activity or if having issues with cough, chest tightness, or unexpected difficulty breathing.
- Compare results: If your exercise value drops by 15–20% or more from baseline, your asthma control is insufficient, and your medication and treatment plan may need adjustment.
Peak flow monitoring is also helpful during illness or when environmental triggers are high (smog, cold weather, smoke, etc.). By catching declines early, athletes can adjust medications and prevent a more serious asthma illness.
Another Benefit of a Peak Flow Meter for the SMART athlete
There are age and height-based “normal” values that can be compared to the Peak baseline and post-exercise values.
I’ve worked with athletes who reported “no asthma or airway issues with exercise” but had relatively low peak flow values compared to anticipated numbers. Once asthma treatment was optimized, the peak flows were closer to the expected values, with noticeable improvement in stamina and reduced fatigue—unlocking a whole new performance level.
No matter which inhaler is used, see the SMART way to use it properly!
What is the SMART Thing to Do?
- Peak Flow Meters: A simple way to track lung function and ensure your asthma is well-controlled is SMART!
- Dual (ICS + LABA) therapy can also be a SMART decision: this approach may offer better protection and performance than traditional albuterol alone.
Have questions about asthma management or how to safely perform at your best with asthma? Contact ActiveKidMD—we’re here to help you make SMART decisions about asthma.
