A 38 year old office worker who had recently taken up jogging as part of a fitness campaign presented to you because his efforts had not proved as successful as he had hoped. He reported a history of asthma since childhood and still had occasional symptoms throughout the year, although normally he was troubled by his wheezing only for a few weeks after viral upper respiratory tract infections. He was being prescribed beclometasone 100 μg regularly twice a day and salbutamol as needed to relieve symptoms. It had been two years since he last had a course of steroids to treat an acute exacerbation.

He had set himself the long term goal of running for an hour after work every day, but had had to curtail his phased exercise programme because of shortness of breath. Using his salbutamol inhaler before running had some effect but was not preventing the problem.