Exercise Induced Bronchospasm

Exercise-induced bronchospasm, non-physicians may call this exercise-induced asthma.

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?

Get a good history, is there a pattern of symptoms?  known triggers that bring on symptoms? Is there an asthma diagnosis in the past? We will do an exam. Objective testing then may be done with baseline spirometry and a bronchodilator challenge (the patient is given albuterol and then we see if symptoms resolve and if the spirometry numbers look better).

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.