Challenges in the Management of Exercise-induced Asthma

William Storms, MD


Expert Rev Clin Immunol. 2009;5(3) 

In This Article

Five-year View

It is this author's opinion that the next 5 years will see a substantial increase in awareness about EIA and EIB, not only among respiratory physicians and athletes, but also among primary care physicians and the general population of patients. The major challenges to date have been appropriate diagnosis, particularly in elite athletes who otherwise may not have symptoms of asthma, followed by appropriate treatment – one that does not simply treat the symptoms, but also addresses the underlying pathology. The recommendation that patients who exercise regularly should use a daily controller medication is a significant step forward, and the number of athletes using controller medications (even if only during their athletic 'season') will undoubtedly grow with better understanding of tolerance to regular β2-agonist use and how controller therapy reduces airway hyper-reactivity and decreases the need for (and, therefore, potential tolerance to) β2-agonists.

This author also believes that we will see a better understanding of the impact of the exercise environment and air quality on lung symptoms, with recommendations for improving air quality being driven by athletes and associated organizations such as the IOC. Until then, we will probably see more athletes with EIA using air masks to filter, warm and humidify their inhaled air. Finally, FDA approval of the mannitol inhalation challenge test will be a big step forward for confirming the diagnosis of asthma and for screening athletes for EIA and EIB in the USA. The simplicity of the test and its documented safety and efficacy for diagnosing EIA (and EIB) will reduce errors of over- and under-diagnosis, thereby ensuring that patients get the treatment they need.


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