Diagnosing and Managing Exercise-Induced Bronchoconstriction

Nicholas Gross, MD, PhD


April 27, 2015


In the past few decades, the importance of regular exercise for health has been recognized and encouraged for everyone, and aerobic activity is an important component of exercise. However, exercise will induce bronchoconstriction in a substantial proportion of the population. The problem is worse in elite athletes, an estimated 70% of whom have EIB. Athletes, however, often minimize, deny, or are even unaware of their EIB symptoms.

To enable anyone with EIB (especially high-level athletes) to function and compete, EIB must be recognized and treated. Furthermore, there is evidence that untreated EIB can have deleterious long-term consequences. Boulet and O'Byrne mention the possibility that during periods of intense training, long-term inflammation of the airways can lead to airway remodeling, immunosuppression, and susceptibility to infections, and possibly to the development of asthma. EIB can nearly always be well controlled.

Competitive athletes must adhere to anti-doping regulations, available here. However, organizing committees should be consulted about specific limitations. In short, the only permitted agents are the inhaled beta2-agonists albuterol, formoterol, and salmeterol. Inhaled anticholinergic agents, inhaled glucocorticoids (but not oral glucocorticoids), leukotriene antagonists, cromolyn, nedocromil, and omalizumab are permitted; all other agents are prohibited. Other limitations (such as dosages) may apply.



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