Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter (original) (raw)
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exerCise-induCed BronChoConstriCtion–Current update and impliCations for treatinG athletes
Exercise-induced bronchoconstriction (EIB) is the occurence of transient airway narrowing that occurs during or after exercise. A number of pathophysio-logical theories exist for the condition, from physio-logical to inhaled air quality and nutrition, all with im-mune mediation. Detailed history and clinical evalu-ation are required to make the diagnosis, substanti-ated by investigations of lung function establishing minimum airway hyperresponsiveness or broncho-dilator response. Chronic management involves the prevention of acute attacks, which includes inhaled glucocorticosteroids and either long-and/or short-acting bronchodilators (beta 2 -agonists), and the use of non-pharmacological agents and methods. Acute asthma can be life-threatening and there are estab-lished guidelines on how to manage this. Prescribing and treating should bear in mind the current anti-dop-ing regulations of the World Anti-Doping Agency.
Exercise-induced bronchoconstriction and asthma
2010
Objectives:The objectives are: (1) to assess diagnostic test characteristics of six alternative index tests compared with the selected reference standard-a standardized exercise challenge test (ECT) in patients with suspected exercise-induced bronchoconstriction or asthma (EIB/EIA); (2) to determine the efficacy of a single prophylactic dose of four pharmacologic and one nonpharmacologic interventions versus placebo to attenuate EIB/EIA in patients with diagnosed EIB/EIA; and (3) to determine if regular daily treatment with short-acting or long-acting beta-agonists (SABA or LABA) causes patients with EIA to develop tachyphylaxis when additional prophylactic doses are used pre-exercise.
Vojnosanitetski pregled. Military-medical and pharmaceutical review, 2014
Physical activity is a common stimulus of asthmatic symptoms manifestation. Airway hyperreactivity is a predisposing cause of exercise induced bronchial obstruction, diagnosed by histamine inhalation. The aim of this study was to determine the relation between the amounts of histamine needed to induce non-specific airway hyperreactivity and exercise-induced bronchial obstruction. This randomized cross-over study included 160 male patients (age 19-27 years) suffering from bronchial asthma who showed positive results as the reaction after the histamine bronchial provocation test. Histamine concentrations were in a range of 0.03 to 4 mg/mL. Each patient participated in the exercise stress test conducted on a conveyor belt. The results of the exercise stress test were considered positive if the FEV1 level dropped by at least 15% from its initial value, 5-10 minutes after the test. All the patients showed positive results as the reaction after the histamine bronchial provocation test, wh...
Recognition and management of exercise-induced bronchospasm
American family physician, 2003
Exercise-induced bronchospasm is an obstruction of transient airflow that usually occurs five to 15 minutes after physical exertion. Although this condition is highly preventable, it is still underrecognized and affects aerobic fitness and quality of life. Diagnosis is based on the results of a detailed history, including assessment of asthma triggers, symptoms suggestive of exercise-induced bronchoconstriction, and a normal forced expiratory volume at one second at rest. A trial of therapy with an inhaled beta agonist may be instituted, with the subsequent addition of inhaled anti-inflammatory agents or ipratropium bromide. Nonpharmacologic measures, such as increased physical conditioning, warm-up exercises, and covering the mouth and nose, should be instituted. If symptoms persist, pulmonary function testing is warranted to rule out underlying lung disease.
Where to from Here for Exercise-Induced Bronchoconstriction
Immunology and Allergy Clinics of North America, 2013
Injury of the epithelium is important in the development of exercise-induced bronchoconstriction (EIB). Airway injury in elite athletes may relate to the large volumes of air inspired during training. Dysregulation of water movement and balance in the airways may contribute to the pathology of EIB. Mast cells, eosinophils, and sensory nerve cells are all likely to be involved in EIB. Cysteinyl leukotrienes are the major mediators of EIB with prostaglandins (PGs) likely to play a role in attenuating (PGE 2) or enhancing (PGD 2) the response. Refractoriness after exercise may relate to desensitization of airway receptors rather than depletion of mediators. New and more sensitive technologies for assaying mediators and measuring changes in pulmonary function are becoming available and will improve our understanding of EIB. Continued Conflict of Interest: T.S. Hallstrand has received research grants from the NIH, American Lung Association, has served as a consultant for Amgen and TEVA pharmaceuticals, and has received lecture fees from Merck & Co.
Pilot study: The effect of reducing treatment on exercise induced bronchoconstriction
Pediatric Pulmonology, 2010
Rationale: Asthma therapy should be stepped up or stepped down in response to changes in asthma control. However, there is little evidence available on the optimal timing, sequence and degree of medication reductions. In this study we analyzed clinically stable asthmatic children who underwent a medication reduction from a combination preparation consisting of an inhaled corticosteroid (ICS) and long acting beta2-agonists (LABA) to monotherapy with the same dose of the ICS. We hypothesized that the extent of exercise induced bronchoconstriction (EIB) would not increase after the cessation of the LABA.
Exercise-Induced Bronchospasm and Allergy
Frontiers in pediatrics, 2017
Sport is an essential part of childhood, with precious and acknowledged positive health effects but the impact of exercise-induced bronchoconstriction (EIB) significantly reduces participation in physical activity. It is important to recognize EIB, differentiating EIB with or without asthma if the transient narrowing of the airways after exercise is associated with asthmatic symptoms or not, in the way to select the most appropriate treatment among the many treatment options available today. Therapy is prescribed based on symptoms severity but diagnosis of EIB is established by changes in lung function provoked by exercise evaluating by direct and indirect tests. Sometimes, in younger children it is difficult to obtain the registration of difference between the preexercise forced expiratory volume in the first second (FEV1) value and the lowest FEV1 value recorded within 30 min after exercise, defined as the gold standard, but interrupter resistance, in association with spirometry, ...
The Journal of Allergy and Clinical Immunology: In Practice, 2020
AAAAI Position Statements, Work Group Reports, and Systematic Reviews are not to be considered to reflect current AAAAI standards or policy after five years from the date of publication. The statement below is not to be construed as dictating an exclusive course of action nor is it intended to replace the medical judgment of healthcare professionals. The unique circumstances of individual patients and environments are to be taken into account in any diagnosis and treatment plan. The statement reflects clinical and scientific advances as of the date of publication and is subject to change. For reference only. Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and