What is this?It is respiratory distress or wheezing that starts within 15 minutes of exercise onset. Usually it resolves within 15-60 minutes after exercise stops. This can occur in endurance athletes, swimming/pool athletes, ice rink athletes or athletes exposed to cold air. Occurs in 5-10% of the general population without asthma. EIB occurs in 90% of asthma patients.
Is it active training that causes EIB? This is a theory in that when elite athletes stop training, most of them do not have EIB. Is it due to a loss of water from the airway that changes airway osmolality and epithelial cell changes? Or is it thermal and there is a loss of heat from the airway and bronchoconstriction occurs?
What do we physicians do?
If testing is positive, then treatment should happen before exercise/ training episodes.
Treatment: Give short-acting beta agonist (albuterol), 15 minutes before exercise. Tolerance can develop if given daily. This may not completely help 15-20% of the population. A second inhaled agent (a steroid) may also be needed. Leukotriene-receptor antagonists (montelukast) may also be given when taken 2 hours before exercise. Anything that can help? pre-exercise warm up and wearing a loosely fitted mask when exercising in cold weather.
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