Exercise induced bronchoconstriction in adults: evidence based diagnosis and management

@article{Smoliga2016ExerciseIB,
  title={Exercise induced bronchoconstriction in adults: evidence based diagnosis and management},
  author={James M. Smoliga and Pnina Weiss and Kenneth William Rundell},
  journal={BMJ : British Medical Journal},
  year={2016},
  volume={352}
}
#### What you need to know EIB is defined as “the transient narrowing of the lower airway following exercise in the presence or absence of clinically recognized asthma.”1 Bronchoconstriction typically develops within 15 minutes after exercise and spontaneously resolves within 60 minutes. After an episode of EIB, there is often a refractory period of about 1-3 hours in which, if exercise is repeated, the bronchoconstriction is less emphasised in 40-50% of patients.2 3 EIB can also occur during… 
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21 Citations
Background Citations
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21 Citations

Exercise and Asthma.
TLDR
Physical training has been shown to be beneficial for asthmatic adults and children in improving asthma control and asthma-related quality of life, and exercise training also reduces the risk of asthma exacerbations, improves exercise capacity, and decreases frequency and severity of EIB.
Management of Exercise-Induced Bronchoconstriction in Athletes.
Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management
TLDR
The burden, key features, diagnosis and current treatment approaches for EIB in patients with and without asthma are described and a call to action for family physicians to be aware of EIB and consider it as a potential diagnosis is served.
Predictors of exercise-induced bronchoconstriction in subjects with mild asthma
TLDR
No functional respiratory parameters seem to predict EIBa in mild asthmatics, however, in those with E IBa, a subgroup developed DH during exercise, and this was associated with a baseline reduced forced expiratory flow rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.
Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations.
Asthma and exercise-induced respiratory symptoms in the athlete: new insights
TLDR
There is a need for more research on prevention of airways dysfunction in athletes, identification of different asthma phenotypes and the benefits of standard asthma medication in this population, in addition to specific issues regarding their treatment and antidoping regulations.
Diagnostic value of bronchoprovocation challenge with adenosine monophosphate versus exercise testing in early diagnosis of asthma.
Let research leave you breathless, not physical exercise!
TLDR
Interestingly, in a 5-year prospective study, subjects who stopped training experienced an attenuation, or in some circumstances disappearance, of EIB, whereas bronchial responsiveness, exercise-induced respiratory symptoms and eosinophilic airway inflammation increased amongst those who continued strenuous physical exercise, regardless of the pharmacological treatment strategies.
β2-agonists in sports: prevalence and impact on athletic performance
Respiratory disorders caused by exercise are expressed in the development of exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA), which are observed in athletes, especially…
Common causes of dyspnoea in athletes: a practical approach for diagnosis and management
TLDR
Common conditions that ultimately cause athletes to report dyspnoea and associated symptoms are reviewed, and insight is provided for developing an efficient diagnostic plan.
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References

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TLDR
The current understanding of exercise-induced bronchoconstriction and vocal cord dysfunction is examined and the mechanism, prevalence, diagnosis, and treatment are discussed.
Air quality and temperature effects on exercise-induced bronchoconstriction.
TLDR
Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool and studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic.
Exercise-induced bronchoconstriction in athletes.
Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
TLDR
Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents and are equally common among girls and boys and can coexist with EIB.
Improving screening and diagnosis of exercise-induced bronchoconstriction: a call to action.
Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma
TLDR
In this group with normal FEV1, mild symptoms, and mild BHR, the sensitivity and specificity for both mannitol and methacholine to identify EIB and a clinician diagnosis of asthma were equivalent, but lower than previously documented in well-defined populations.
High prevalence of exercise-induced laryngeal obstruction in athletes.
TLDR
In athletes with unexplained respiratory symptoms, EILO is an important differential diagnosis not discerned from other etiologies by clinical features, which has important implications for the assessment and management of athletes presenting with persistent respiratory symptoms despite asthma therapy.
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TLDR
The findings suggest that the pathogenesis of EIB in elite athletes might be different from that of asthma, and as such, neither symptoms nor the methacholine challenge test should be used exclusively for identifying EIB.
Inspiratory stridor in elite athletes.
TLDR
The lack of a beta(2)-agonist response in combination with postexercise serial spirometry can be useful in excluding solitary IS and confirming EIB diagnosis.
Monitoring Pulmonary Function During Exercise in Children With Asthma
TLDR
Exercise-induced bronchospasm (EIB) is defined as acute, reversible bronchoconstriction induced by exercise and two variations have been described: one with symptoms occurring during exercise and another with Symptoms occurring after exercise.
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