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The Exercise-Induced Bronchoconstriction GUIDELINES Pocket Guide is endorsed by the American Thoracic Society and is based on the latest published guidelines. This practical quick-reference tool contains Diagnostic criteria, graded recommendations for treatment, a diagnostic and treatment algorithm and complete drug tables.
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The roots of the American Thoracic Society reach back to 1905, when a small group of physicians decided that the best way to improve care for tuberculosis patients was to share their experiences and discoveries. Today, the ATS has grown into an international society with more than 15,000 members. In this introductory section, you will find information about the people and programs that make the ATS the world's leading medical association dedicated to advancing our clinical and scientific understanding of pulmonary diseases, critical illnesses and sleep-related breathing disorders.
Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma but may also occur in individuals without known asthma.
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 EIB is present and to quantify the severity of the disorder. It is preferable to assess FEV1, 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 FEV1 used to diagnose EIB is ≥10%.
The severity of EIB can be graded as follows:
Percent fall in FEV1 from the pre-exercise level
Severity
10%-24%
Mild
25%-49%
Moderate
≥50%
Severe
A number of surrogates for exercise testing have been developed that may be easier to implement than exercise challenge. These surrogates include eucapnic voluntary hyperpnea or hyperventilation, hyperosmolar aerosols, including 4.5% saline, and dry powder mannitol.
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