A group of 22 runners from the Washington Running Club training for the 2013 Marine Corps Marathon. (Katherine Frey/The Washington Post)

Asthma: It’s that first breath that always seems the worst.

The chest tightens and the breath shortens. A cough, a wheeze and an attack.

Especially when it’s exacerbated by the cold of winter, asthma is a discomfort for some and a medical issue for many.

Almost 19 million American adults have adult-onset asthma, a chronic lung disease that inflames and narrows the airways. About 90 percent of them — plus about 10 percent of the general population — periodically suffer a related condition called exercise-induced bronchoconstriction, in which someone running or doing other strenuous exercise suddenly struggles to be able to breathe, with little or no warning.

It’s understandable that adults with these conditions — and there are more all the time, doctors say, due partly to poor air quality and other environmental factors —may find some types of fitness to be an arduous endeavor that ultimately won’t be worth the effort.

But experts say that knowledge of both conditions is improving and, in consultation with physicians, it is possible for sufferers to exercise and maintain an active lifestyle.

“Ten percent of Olympic athletes have asthma, so asthma won’t stop individuals from high functionality,” said Albert Rizzo, chief of Christiana Care Health System’s pulmonary and critical care medicine section and senior medical advisor for the American Lung Association. “With medication, they can go a long way.”

In fact, exercise can have beneficial effects on your asthma symptoms. “Exercise and staying fit is recommended with asthma, whether it is adult-onset or exercise-induced,” said Lisa Gilmore, former director of the National Capital Asthma Coalition and webmaster of the Washington information resource dcasthma.org. “Asthma is very controllable, if you’re following the asthma guidelines and taking medication as needed.

Those guidelines, which come from the National Asthma Control Initiative, include using inhaled corticosteroids, assessing the severity of your asthma to determine what types of treatment are needed, developing and using a written asthma action plan, making regular follow-up appointments with your physician and trying to control environmental triggers. Some triggers are easy to control, such as smoking, while others — for example, dust and mold in work spaces — might be a little tougher to manage.

Though asthma, especially in children, sometimes seems to disappear on its own, it generally cannot be cured. But it can be effectively treated, with knowledge and careful management.

“For adult asthmatics, it doesn’t tend to get better but it doesn’t have to get worse,” said Janna Tuck, an allergist and spokesperson for the American College of Allergy, Asthma and Immunology.

Jill Selman, a high school teacher in Montgomery County, had her asthma under control with medication when she began running six years ago. But three years ago, her symptoms flared up in a major way.

“I could barely run a minute anymore. A lap was hard,” Selman said. “But my awesome allergist at Rockville Asthma and Allergy encouraged me to exercise and run. My doctor said to do it long-term helps expand my lung capacity.”

So she kept running. And slowly but surely, she was able to train for the Marine Corps Marathon in October 2014. “The training went great. I could run 16 to 21 miles with no problem,” Selman said. Even when a bacterial infection called cellulitis appeared on her leg just 10 days before the race, she didn’t give up. She ran — a little slower than she’d hoped, but she finished.

Selman wants to run the Marine Corps Marathon again, this time as part of a charity campaign, working with kids who have disabilities. Thanks to Selman’s allergists, her asthma is controlled, with low doses of medication and allergy shots once a month.

“I think when you have health issues, you need to be sensitive to your own bio-feedback. Know your limits, when you can push and when you can say, ‘ummm, not today.’” Selman said. “It’s the best gift to give yourself to take care of yourself.”

An important tool in managing these types of asthma is recognizing the specific triggers that set off coughing, wheezing, or trouble breathing. Rizzo said that for those with exercise-induced bronchoconstriction, “if you know your initial potential triggers when you go about exercise and know how to manage them, that’s all you need to do.”

Even if there’s uncertainty about whether struggles with breathing are related to asthma or another respiratory issue, going to a physician getting a referral to an allergist are important.

Rizzo suggests having a good assessment of the family history ready for the appointment. Physicians will want to know if allergies in the family and if the patient struggled with asthma or other respiratory issues as a child.

Rizzo and Tuck also recommended a ‘pre-treatment’ strategy before exercising: Use a quick relief inhaler about 10-15 minutes before working out, then do a 10-15-minute gradual warm-up before strenuous activity.

If you’re out in cold weather, try to breathe through the nose, which helps humidify the air so the airways won’t dry out. Wearing a mouth covering or some type of scarf also helps.

The Mayo Clinic also suggests that eating a low-salt diet, fatty fish such as salmon and tuna, as well as fruits and vegetables high in Vitamin C, may help with symptoms.

The most effective way to manage asthma, experts agree, is to manage attitude and perspective. While asthma is a disease, it’s not a life sentence limiting you to minimal activity.

“I think because of the subtlety of the symptoms, any questions people about their asthma, they should see their physicians,” Tuck said. “You shouldn’t say ‘I’m not 20 anymore’ and give up. That may be true but you deserve to have good lung health. Go and be evaluated.”

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