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Exercise-Induced AsthmaAka: Exercise-Induced Bronchospasm, Exercise Induced Bronchospasm, EIB
- See Also
- Asthma
- Exercise-Induced Anaphylaxis
- Exercise-Induced Urticaria
- Pathophysiology
- Hyperventilation of dry, cool air
- Loss of heat or water from lungs during Exercise
- Epidemiology
- Occurs in 90% of Asthmatics
- May occur in as many as 29% of athletes
- Symptoms
- Timing
- Onset during or after Exercise
- Does not usually affect first 5 minutes of Exercise
- Symptom duration of 5 minutes or longer
- Exercise-related symptoms
- Shortness of Breath
- Wheezing
- Decreased Exercise endurance
- Chest tightness
- Cough
- Epigastric Pain
- Pharyngitis
- Signs
- Cardiopulmonary exam normal at rest
- Exclude associated conditions
- Chronic Sinusitis
- Allergic Rhinitis
- Nasal Polyps
- Septal deviation
- Vocal cord dysfunction
- Diagnostics
- Obtain FEV1 or Peak Flow at rest (exclude Asthma)
- Exercise challenge with Pulmonary Function Testing
- Not required for classic presentation
- Most patients may be treated empirically
- Management: General Measures
- Maintain regular Exercise for physical conditioning
- Warm up and cool down for 10 minutes before and after
- Exercise in humidified, warm environment
- Cover nose and mouth during cold weather Exercise
- Avoid Exercise within 2 hours following a meal
- Avoid Exercise in high allergen, ozone or pollution
- Management: Medications
- Treat related conditions (e.g. Allergic Rhinitis)
- Step 1: Short-acting Beta Agonist (Albuterol)
- Use 2 puffs, 15-30 minutes before Exercise
- Step 2: Mast Cell Stabilizer 15 minutes before Exercise
- Consider using on regular schedule 2-4 times daily
- Cromolyn (Intal)
- Nedocromil (Tilade)
- Step 3: Inhaled Corticosteroid trial
- Obtain initial Exercise challenge with PFTs
- Inhaled Corticosteroid for 4 weeks
- Obtain follow-up Exercise challenge with PFTs
- Continue Inhaled Corticosteroid if benefit seen
- Step 4: Ipratropium Bromide (Atrovent)
- Inhaled 2 puffs up to qid
- Step 5: Leukotriene Modifiers
- Taken on regular schedule
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Other interventions with unproven benefit
- Vitamin C 2 grams before Exercise
- Dietary salt reduction
- Sporting organization guidelines
- U.S. Olympic Committee
- No approval needed
- Ipratropium Bromide
- Leukotriene Modifiers
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Theophylline
- Mast Cell Stabilizers
- Cromolyn (Intal)
- Nedocromil (Tilade)
- Prior approval required
- Inhaled Corticosteroids
- Inhaled Beta Agonist
- Albuterol (Proventil, Ventolin)
- Terbutaline (Brethine)
- Salmeterol (Serevent)
- National Collegiate Athletic Association (NCAA)
- Oral (not inhaled) beta 2 agonists prohibited
- All other Asthma medications approved
- References
- Sinha (2003) Am Fam Physician 67(4):769
- Tan (2002) Ann Allergy {a 11946} Immunol 89:226
- Tan (1998) Sports Med 25:4
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