Exercise induced bronchoconstriction in adults: evidence based diagnosis and management

Smoliga, James M.; Weiss, Pnina; Rundell, Kenneth W.

doi:10.1136/bmj.h6951

Cited by 29 publications

(13 citation statements)

References 47 publications

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“…Reductions in FEV 1 due to cold air are from the reduced water content of the air, rather than the low temperature. 34 The inhaled water content from the ambient conditions of the race was 15% lower than in an indoor exercise laboratory. (The race conditions were 47°F (8°C) and ϳ88% humidity, thus the inhaled water content would be ϳ6.2 g of water per kg of air [7.4 g/m 3 ], which is 15% lower than in an exercise laboratory, at 68°F (20°C) and 50% humidity [7.3 g/kg or 8.7 g/m 3 ] [https://www.lenntech.com/calculators/humidity/ relative-humidity.htm] Accessed June 12, 2018).…”

Section: Discussionmentioning

confidence: 97%

Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

Zavorsky

Zimmerman

Shendell³

et al. 2018

Respir Care

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Section: Discussionmentioning

confidence: 97%

Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

Zavorsky

Zimmerman

Shendell³

et al. 2018

Respir Care

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“…Overall, the management of asthma/EIB in athletes should be similar to nonathletes, although some specific aspects of treatment and antidoping regulations have to be considered. 4,65,134,135 It is important to note that current asthma medications are not ergogenic if used at appropriate dose and frequency. 4,136 Athletes with frequent EIB should take regular ICS to help decrease airway responsiveness over time.…”

Section: Prevention Of Exercise-induced Bronchoconstriction In Athletesmentioning

confidence: 99%

Exercise and Asthma

Côté

Turmel

Boulet

2018

Semin Respir Crit Care Med

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Transient airway narrowing can occur during or following exercise, a phenomenon called exercise-induced bronchoconstriction (EIB). The main mechanism of EIB is considered to be airway dehydration, resulting from increased ventilation during exercise. In asthma, such water loss causes an increase in airway fluid osmolarity, inducing airway smooth muscle contraction following the release of mediators from airway inflammatory cells. Asthmatics frequently experience EIB, but it may also be observed in others not reporting asthma symptoms, particularly elite endurance athletes. Individuals with asthma often refrain from performing physical exercise because they fear troublesome respiratory symptoms. However, in addition to its well-known cardiovascular and metabolic benefits, physical training has been shown to be beneficial for asthmatic adults and children in improving asthma control and asthma-related quality of life. Exercise training also reduces the risk of asthma exacerbations, improves exercise capacity, and decreases frequency and severity of EIB. To minimize the risk of EIB, asthma must be well controlled, and specific pharmacological and nonpharmacological preventative measures can be taken. Counterintuitively, in high-level athletes, the development of asthma, airway hyperresponsiveness, and EIB can be promoted by intense training over many years following exposure to environmental conditions, such as cold air, pollutants, and allergens. As for nonathletes, athletes must have optimal asthma control and apply preventative measures against EIB, taking into account antidoping regulations for asthma medications. A better understanding of the impact of exercise on asthma should improve the overall care of asthmatic patients.

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“…The diagnostic accuracy for these challenge tests has been well established, so it is necessary to perform them in accordance with the recommended protocols without modification [ 11 ]. Withholding schedules for medications must be properly followed [ 26 ]. Additionally, some athletes who are positive for EIB may sometimes test negative and thus two tests may be required [ 27 ].…”

Section: Asthma and Exercise-induced Bronchoconstrictionmentioning

confidence: 99%

Common causes of dyspnoea in athletes: a practical approach for diagnosis and management

Smoliga

Mohseni

Berwager

et al. 2016

Breathe

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Key points“Dyspnoea” during exercise is a common complaint in seemingly otherwise healthy athletes, which may be associated with fatigue and underperformance.Because dyspnoea is an general term and may be caused by numerous factors, ranging from poor aerobic fitness to serious, potentially fatal respiratory and nonrespiratory pathologies, it is important for clinicians to obtain an appropriate case history and ask relevant exercise-specific questions to fully characterise the nature of the complaint so that a targeted diagnostic plan can be developed.Exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction are two common causes of dyspnoea in athletes, and both are regularly misdiagnosed and mismanaged due to poor adherence to available practice parameters.Aside from airway dysfunction, iron deficiency and anaemia, infectious disease, and musculoskeletal conditions are common problems in athletes which ultimately may lead to complaints of dyspnoea.Educational aimsTo inform readers of the common causes of dyspnoea encountered in athletes.To highlight that airway diseases, such as asthma and exercise-induced bronchoconstriction, are commonly misdiagnosed and mismanaged.To introduce readers to common nonairway causes of dyspnoea in athletes, including clinical features and general principles of diagnosis, and management.To emphasise the importance of a detailed case history and proper adherence to established protocols in evaluating and managing the dyspnoeic athlete.To provide readers with a general framework of appropriate questions that are useful for developing a targeted diagnostic plan for evaluating dyspnoeic athletes.Dyspnoea during exercise is a common chief complaint in athletes and active individuals. It is not uncommon for dyspnoeic athletes to be diagnosed with asthma, “exercise-induced asthma” or exercise-induced bronchoconstriction based on their symptoms, but this strategy regularly leads to misdiagnosis and improper patient management. Dyspnoea during exercise can ultimately be caused by numerous respiratory and nonrespiratory conditions, ranging from nonpathological to potentially fatal in severity. As, such it is important for healthcare providers to be familiar with the many factors that can cause dyspnoea during exercise in seemingly otherwise-healthy individuals and have a general understanding of the clinical approach to this patient population. This article reviews common conditions that ultimately cause athletes to report dyspnoea and associated symptoms, and provides insight for developing an efficient diagnostic plan.

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Exercise induced bronchoconstriction in adults: evidence based diagnosis and management

Cited by 29 publications

References 47 publications

Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

Acute Reduction in Spirometry Values After Prolonged Exercise Among Recreational Runners

Exercise and Asthma

Common causes of dyspnoea in athletes: a practical approach for diagnosis and management

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