Exercise-induced bronchospasm: A case study in a nonasthmatic patient (original) (raw)
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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.
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.
Improving Screening and Diagnosis of Exercise-Induced Bronchoconstriction: A Call to Action
The Journal of Allergy and Clinical Immunology: In Practice, 2014
This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis of exerciseinduced bronchoconstriction (EIB), a transient airway narrowing that occurs during and most often after exercise in people with and without underlying asthma. EIB is both commonly underdiagnosed and overdiagnosed. EIB underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Routine use of a reliable and valid self-administered EIB screening questionnaire by professionals best positioned to screen large numbers of people could substantially improve the detection of EIB. The authors conducted a systematic review of the literature that evaluated the accuracy of EIB screening questionnaires that might be adopted for widespread EIB screening in the general population. Results of this review indicated that no existing EIB screening questionnaire had adequate sensitivity and specificity for this purpose. The authors present a call to action to develop a new EIB screening questionnaire, and discuss the rigorous qualitative and quantitative research necessary to develop and validate such an instrument, including key methodological pitfalls that must be avoided. Ó Exercise-induced bronchoconstriction (EIB) is a common clinical problem in persons with asthma and also occurs in some people who lack other features of asthma. Despite evidence-based clinical practice guidelines for the diagnosis and management of EIB, 1,2 physicians frequently underdiagnose and overdiagnose EIB, which suggests that many physicians are not adhering to these recommendations. Physicians' poor performance in diagnosing EIB may be due to a number of issues, including a lack of awareness of the prevalence and burden of this condition, the absence of an effective screening questionnaire to help detect EIB, and inadequate knowledge about how to further evaluate and treat patients with suspected EIB.
Journal of Asthma and Allergy, 2021
Purpose Exercise-induced bronchoconstriction (EIB) is generally treated with short-acting β2-agonists (SABA) before exercising, to prevent symptoms. Real-world data on treatments and outcomes for patients with EIB alone (EIBalone), or with asthma (EIBasthma), in the USA are limited. This study compared demographics, treatment patterns, morbidity, and costs of treating EIB between these two groups of patients. Patients and Methods Administrative claims from US IBM® MarketScan® Research databases were analyzed retrospectively. Patients aged ≥4 years filling a SABA claim between 1/1/2011 and 12/31/2016 were evaluated. Patients were indexed on a random SABA claim and required to have 12 months’ continuous eligibility pre- and post-index, ≥1 maintenance medication and/or SABA fill post-index, and were designated EIBalone or EIBasthma according to diagnostic codes (EIB only or EIB plus asthma, respectively). Descriptive statistics were used. Results In total, 13,480 patients had EIBalone ...
Current opinion in pulmonary medicine, 2009
Exercise has been recognized as a trigger of bronchospasm for centuries. However, there remains much debate regarding the mechanism of this response, nomenclature to describe it, optimal tests for diagnosis, and treatment options. There is a need to review recent findings in this area both for clinicians and to highlight areas in need of additional research. Recent data have confirmed the high prevalence of exercise-induced bronchospasm among athletes and raise concern that many of these athletes may be unaware of this diagnosis. Variability in nomenclature, classification, and diagnostic testing methods continue to make comparisons among reported trials difficult. Both in-vitro and animal studies reveal a heterogeneous inflammatory response correlated with exercise-induced bronchospasm. This variability may underlie the variable response to pharmacotherapy. Clinicians need to be alert to the nonspecific nature of exercise-induced symptoms and increase utilization of objective testi...
Exercise-induced bronchodilation in asthma
CHEST Journal, 1985
Of 34 symptomatic adult asthmatic patients (23 men) aged 51 ± 13 years (mean ± 1 SD) with moderately severe airways obstruction who underwent maximal exercise testing at room temperature (22#{176}C) and humidity (44 percent RH) MATERIALS AND METHODS We studied in detail seven men, aged 56 ± 9 (mean ± 1 SD), who satisfied the criteria for asthma. These seven patients were chosen from a larger group of 34 consecutively studied symptomatic adult asthmatic patients (23 men) aged 51 ± 13 years) who had undergone lung function and exercise studies for evaluation of dyspnea or wheezing as part of a rehabilitation program. These seven patients were selected for further study because they demonstrated an improvement in forced expired volume in one second (FEV,) following exercise of 20 percent above the resting value. All seven patients were lifelong nonsmokers with long-standing history of
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 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, ...