Pulmonology Book

Asthma and Bronchospastic Disorders

Chronic Obstructive Pulmonary Disease

http://www.fpnotebook.com/

Exercise-Induced AsthmaAka: Exercise-Induced Bronchospasm, Exercise Induced Bronchospasm, EIB

Advertisement

  1. See Also
    1. Asthma
    2. Exercise-Induced Anaphylaxis
    3. Exercise-Induced Urticaria
  2. Pathophysiology
    1. Hyperventilation of dry, cool air
    2. Loss of heat or water from lungs during Exercise
  3. Epidemiology
    1. Occurs in 90% of Asthmatics
    2. May occur in as many as 29% of athletes
  4. Symptoms
    1. Timing
      1. Onset during or after Exercise
      2. Does not usually affect first 5 minutes of Exercise
      3. Symptom duration of 5 minutes or longer
    2. Exercise-related symptoms
      1. Shortness of Breath
      2. Wheezing
      3. Decreased Exercise endurance
      4. Chest tightness
      5. Cough
      6. Epigastric Pain
      7. Pharyngitis
  5. Signs
    1. Cardiopulmonary exam normal at rest
    2. Exclude associated conditions
      1. Chronic Sinusitis
      2. Allergic Rhinitis
      3. Nasal Polyps
      4. Septal deviation
      5. Vocal cord dysfunction
  6. Diagnostics
    1. Obtain FEV1 or Peak Flow at rest (exclude Asthma)
    2. Exercise challenge with Pulmonary Function Testing
      1. Not required for classic presentation
      2. Most patients may be treated empirically
  7. Management: General Measures
    1. Maintain regular Exercise for physical conditioning
    2. Warm up and cool down for 10 minutes before and after
    3. Exercise in humidified, warm environment
    4. Cover nose and mouth during cold weather Exercise
    5. Avoid Exercise within 2 hours following a meal
    6. Avoid Exercise in high allergen, ozone or pollution
  8. Management: Medications
    1. Treat related conditions (e.g. Allergic Rhinitis)
    2. Step 1: Short-acting Beta Agonist (Albuterol)
      1. Use 2 puffs, 15-30 minutes before Exercise
    3. Step 2: Mast Cell Stabilizer 15 minutes before Exercise
      1. Consider using on regular schedule 2-4 times daily
      2. Cromolyn (Intal)
      3. Nedocromil (Tilade)
    4. Step 3: Inhaled Corticosteroid trial
      1. Obtain initial Exercise challenge with PFTs
      2. Inhaled Corticosteroid for 4 weeks
      3. Obtain follow-up Exercise challenge with PFTs
      4. Continue Inhaled Corticosteroid if benefit seen
    5. Step 4: Ipratropium Bromide (Atrovent)
      1. Inhaled 2 puffs up to qid
    6. Step 5: Leukotriene Modifiers
      1. Taken on regular schedule
      2. Montelukast (Singulair)
      3. Zafirlukast (Accolate)
    7. Other interventions with unproven benefit
      1. Vitamin C 2 grams before Exercise
      2. Dietary salt reduction
  9. Sporting organization guidelines
    1. U.S. Olympic Committee
      1. No approval needed
        1. Ipratropium Bromide
        2. Leukotriene Modifiers
          1. Montelukast (Singulair)
          2. Zafirlukast (Accolate)
        3. Theophylline
        4. Mast Cell Stabilizers
          1. Cromolyn (Intal)
          2. Nedocromil (Tilade)
      2. Prior approval required
        1. Inhaled Corticosteroids
        2. Inhaled Beta Agonist
          1. Albuterol (Proventil, Ventolin)
          2. Terbutaline (Brethine)
          3. Salmeterol (Serevent)
    2. National Collegiate Athletic Association (NCAA)
      1. Oral (not inhaled) beta 2 agonists prohibited
      2. All other Asthma medications approved
  10. References
    1. Sinha (2003) Am Fam Physician 67(4):769
    2. Tan (2002) Ann Allergy {a 12297} Immunol 89:226
    3. Tan (1998) Sports Med 25:4

Asthma, Exercise-Induced (C0004099)

Definition (MSH)Asthma attacks following a period of exercise. Usually the induced attack is short-lived and regresses spontaneously. The magnitude of postexertional airway obstruction is strongly influenced by the environment in which exercise is performed (i.e. inhalation of cold air during physical exertion markedly augments the severity of the airway obstruction; conversely, warm humid air blunts or abolishes it).
ConceptsDisease or Syndrome (T047)
MSHD001250
EnglishASTHMA EXERCISE IND, EIA - Exercise-induced asthma, EXERCISE IND ASTHMA, Exercise Induced Asthma, Exercise-induced asthma, Exercise-Induced Asthmas
Spanishasma inducida por el ejercicio, asma inducido por el ejercicio
Parent ConceptsAsthma (C0004096), Airway Obstruction (C0001883), Bronchial Diseases (C0006261), Duplicate concept (C1274013), Obstruction of lower respiratory tract (C1960171)
SourcesMSH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree