What are recommended treatment guidelines for exercise-induced bronchoconstriction (EIB) (exercise-induced asthma)?

Updated: Jan 07, 2019
  • Author: Michael J Morris, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

In 2013, the American Thoracic Society released clinical guidelines for the management of exercise-induced bronchoconstriction (EIB), which included the following recommendations [111] :

  • Administration of an inhaled SABA before exercise (strong recommendation); the SABA is typically administered 15 minutes before exercise
  • A controller agent is added whenever SABA therapy is used daily or more frequently
  • Interval or combination warm-up exercise before planned exercise (strong recommendation)
  • Recommend against daily use of an inhaled long-acting beta2-agonist as single therapy (strong recommendation)
  • For patients who continue to have symptoms despite using an inhaled SABA before exercise or who require an inhaled SABA daily or more frequently: (1) Daily ICS (strong recommendation), (2) Daily administration of an LTRA (strong recommendation), (3) Administration of a mast cell‒stabilizing agent before exercise (strong recommendation), and (4) Inhaled anticholinergic agent before exercise (weak recommendation)
  • For patients with EIB and allergies who continue to have symptoms despite using an inhaled SABA before exercise or who require an inhaled SABA daily or more frequently consider administration of an antihistamine (weak recommendation)
  • For exercise in cold weather, routine use of a device (eg, mask) that warms and humidifies the air during exercise (weak recommendation)

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