Treatment of Exercise-induced Bronchoconstriction

Publication Date: May 1, 2013

Diagnosis

  • The diagnosis of EIB is established by changes in lung function provoked by exercise, not on the basis of symptoms.
  • Serial lung function measurements after a specific exercise or hyperpnea challenge are used to determine if EIB1 is present and to quantify the severity of the disorder. It is preferable to assess FEV, because this measurement has better repeatability and is more discriminating than peak expiratory flow rate.
  • The airway response is expressed as the percent fall in FEV1 from the baseline value. The difference between the pre-exercise FEV1 value and the lowest FEV1 value recorded within 30 minutes after exercise is expressed as a percentage of the pre-exercise value. The criterion for the percent fall in FEV used to diagnose 1EIB is ≥10%.
  • The severity of EIB can be graded as follows:

Treatment

For patients with EIB, the ATS2 recommends administration of an inhaled short-acting β-agonist (SABA) before exercise. (S, H)
The SABA is typically administered 15 minutes before exercise.
620

For patients with EIB who continue to have symptoms despite using an inhaled SABA before exercise, or who require an inhaled SABA daily or more frequently:

The ATS recommends against daily use of an inhaled long-acting β2-agonist as single therapy. (S, M)
This is based upon a strong concern for serious side effects.
620
The ATS recommends daily administration of an inhaled corticosteroid (ICS). (S, M)
It may take 2-4 weeks after the initiation of therapy to see maximal improvement.
620
The ATS recommends against administration of ICS only before exercise. (S, M)
620
The ATS recommends daily administration of a leukotriene receptor antagonist. (S, M)
620
The ATS recommends administration of a mast cell stabilizing agent before exercise. (S, H)
620
The ATS suggests administration of an inhaled anticholinergic agent before exercise. (C, L)
620
For patients with EIB and allergies who continue to have symptoms despite using an inhaled SABA before exercise, or who require an inhaled SABA daily or more frequently, the ATS suggests administration of an antihistamine. (C, M)
620
In contrast, the ATS recommends against administration of antihistamines in patients with EIB who do not have allergies. (S, M)
620
For all patients with EIB, the ATS recommends interval or combination warm-up exercise before planned exercise. (S, M)
620
For patients with EIB who exercise in cold weather, the ATS suggests routine use of a device (i.e., mask) that warms and humidifies the air during exercise. (C, L)
620

For patients with EIB who have an interest in dietary modification to control their symptoms:

The ATS suggests implementation of a low-salt diet. (C, M)
620
The ATS suggests dietary supplementation with fish oils. (C, L)
620
The ATS suggests against dietary supplementation with lycopene. (C, L)
620
The ATS suggests dietary supplementation with ascorbic acid. (C, M)
620

Recommendation Grading

Disclaimer

Overview

Title

Treatment of Exercise-induced Bronchoconstriction

Authoring Organization

Publication Month/Year

May 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Childcare center, School

Intended Users

Athletics coaching, nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D001250 - Asthma, Exercise-Induced

Keywords

exercise-induced bronchoconstriction, exercise-induced bronchospasm, exercise-induced asthma, sports-related asthma, EIB

Supplemental Methodology Resources

Data Supplement