Exercise-induced Bronchoconstriction Symptoms Research Articles

Managing Exercise-Induced Bronchoconstriction: A Comprehensive Review of Strategies for Athletes to Maintain Fitness and Health

Exercise-induced bronchoconstriction (EIB) significantly impacts athletes by impairing their performance and overall health. Characterized by airway narrowing during or after physical activity, EIB affects the quality of training and competition. This study employs a qualitative descriptive research model based on a comprehensive literature review to evaluate EIB management strategies in athletes. We systematically collected data from trusted scientific databases—Scopus, Science Direct, and Google Scholar—using keywords such as "Exercise-Induced Asthma," "Athlete," and "Sport." Relevant articles were identified, and key terms related to EIB management were reviewed. The data, including study designs, research objectives, sample sizes, and findings, were compiled and analyzed to determine effective management approaches. Key findings indicate that accurate diagnosis using spirometry and bronchial provocation tests is essential. Pharmacological management primarily involves inhaled corticosteroids (ICS) to reduce inflammation and control EIB, while short-acting beta agonists (SABAs) offer only temporary relief. Non-pharmacological strategies include avoiding triggers, implementing proper warm-up routines, and using breathing techniques. Supervised aerobic exercise programs were shown to improve cardiovascular fitness without worsening EIB symptoms. The study also reviewed the impact of environmental factors, such as air pollution and post-COVID-19 conditions, on EIB. Recommendations include personalized asthma action plans, training for coaches on environmental triggers, and exercising in controlled conditions. This study highlights the need for a holistic approach combining pharmacological and non-pharmacological methods to manage EIB effectively and maintain athletic performance. Further research is warranted to develop tailored strategies for athletes with EIB.

Exercise-Induced Bronchoconstriction in Children: A Comparison between Athletes and Non-Athletes.

Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction. This study is a retrospective analysis of two prospective studies concerning EIB symptoms in two adolescent populations. Our study group included 400 non-athletes and 101 athletes. Due to the similarity of indoor exercise conditions, an analysis was performed on the basis of where training took place. The study aims to assess the EIB prevalence in the following groups of adolescent children: non-athletes and athletes. In "indoor" athletes, the EIB prevalence was 22.4%. Among non-athletes, EIB was diagnosed in 10.2% (p = 0.007). A history of asthma was found in 6.5% of non-athletes and 29.3% of indoor athletes (p < 0.001). The incidence of EIB without asthma was higher in indoor athletes (14.6%) than in non-athletes (9.9%). Athletes achieved higher mean values in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum expiratory flow rate at 25% (MEF25) parameters. In the group of non-athletes, higher results were observed in forced expiratory volume in one second % of vital capacity (FEV1%VC), MEF50, and MEF75. The findings of the study present the complexity of the EIB diagnosis among children training in an indoor environment.

Small airway dysfunction in asthmatic patients treated with as-needed SABA monotherapy: A perfect storm

BackgroundShort-acting beta agonist (SABA)-only treatment is associated with poor asthma control and adverse clinical outcomes. The importance of small airway dysfunction (SAD) is increasingly recognized in asthma, but less is known in patients using SABA-only therapy. We aimed to investigate the impact of SAD on asthma control in an unselected cohort of 60 adults with physician-diagnosed intermittent asthma treated with as-needed SABA monotherapy. MethodsAll patients underwent standard spirometry and impulse oscillometry (IOS) at the first visit and were stratified by the presence of SAD defined by IOS (fall in resistance 5–20 Hz [R5-R20]>0.07 kPa × s*L−1). Univariable and multivariable analyses were used to analyze cross-sectional relationships between clinical variables and SAD. ResultsSAD was present in 73% of the cohort. Compared with patients without SAD, adults with SAD had a higher number of severe exacerbations (65.9% versus 25.0%, p < 0.05), higher use of annual SABA canisters (median (IQR), 3 (1.75–3) versus 1 (1–2), p < 0.001), and significantly less well-controlled asthma (11.7% versus 75.0%, p < 0.001). Spirometry parameters were similar between patients with IOS-defined SAD and those without SAD. The multivariable logistic regression analysis showed that exercise-induced bronchoconstriction symptoms (EIB, odds ratio [OR] 31.18; 95%CI:4.85–365.00) and night awakenings due to asthma (OR 30.30; 95%CI:2.61–1141.00) were independent predictors of SAD, with a high predictive power of the model incorporating these baseline predictors (AUC 0.92). ConclusionsEIB and nocturnal symptoms are strong predictors of SAD in asthmatic patients using as-needed SABA-monotherapy, helping to distinguish subjects with SAD among patients with asthma when IOS cannot be performed.

The feasibility of eucapnic voluntary hyperpnoea for the diagnosis of exercise-induced bronchoconstriction in a community pulmonary practice

Objective Exercise-induced bronchoconstriction (EIB) is a common condition and is typically treated empirically based on symptoms alone. However, symptoms of EIB are typically nonspecific. Objective testing with eucapnic voluntary hyperpnea (EVH) is a sensitive and specific method to diagnose EIB and may suggest alternative etiologies such as exercise-induced laryngeal obstruction (EILO). To this point, EVH has been primarily utilized in large academic centers and in elite athletes. We intend to discuss the feasibility and clinical application of utilizing EVH to diagnose EIB in a community-based pulmonary practice. Methods Retrospective analysis of 62 patients who completed EVH at The Oregon Clinic Pulmonary Clinic. Patients with inspiratory flow volume loop flattening or clinical symptoms were assessed by otolaryngology for evidence of EILO. Results: 61 of 62 patients were included in the final analysis. 52 of 61 patients (85%) achieved an interpretable test with a maximum voluntary ventilation (MVV) >60%. There was no difference in baseline spirometry or patient characteristics between those who were able to reach an MVV >60% and those who did not. 14 (23%) patients were diagnosed with EIB, 18 (30%) with EILO, and 4 (7%) were diagnosed with both EIB and EILO. Only 1 patient had a non-diagnostic evaluation with MVV <60% and negative for EIB and EILO. Conclusions EVH is a feasible diagnostic modality to evaluate for EIB in a community pulmonary practice and may suggest alternative conditions such as EILO. Accurate diagnosis is paramount to prescribing proper therapy, decreasing inappropriate medication use, and relieving exercise-induced symptoms.

Can Pediatricians Assess Exercise-Induced Bronchoconstriction From Post-exercise Videos?

Objective: Exercise-induced bronchoconstriction (EIB) is a highly prevalent morbidity of childhood asthma and defined by a transient narrowing of the airways during or after physical exercise. An exercise challenge test (ECT) is the reference standard for the diagnosis of EIB. Video evaluation of EIB symptoms could be a practical alternative for the assessment of EIB. We studied the ability of pediatricians to assess EIB from post-exercise videos.Methods: A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) and EIB was measured with a standardized ECT performed in cold, dry air. EIB was defined as a fall in forced expiratory volume in 1 s (FEV1) of ≥10% post-exercise. Children were filmed before and after exercise in frontal position and bare chested. The clinical assessment results and videos were shown to 20 pediatricians (mean experience 14.4 years). Each assessed EIB severity in 5 random children providing 100 assessments, scored on a continuous rating scale (0–10) and in severity classifications (no, mild, moderate, severe) using a scoring list including physical asthma symptoms. Correlations between predicted scores and objective scores were calculated with Spearman's rho and Cohen's Kappa. A generalized linear model was used to assess the relationship between physical symptoms and fall in FEV1.Results: Median fall in FEV1 after exercise was 15.1% (IQR 1.2–65.1). Pediatricians detected EIB with a sensitivity of 78% (95% CI 66–87%) and a specificity of 40% (95% CI 27–55%). The positive predictive value for a pediatricians' diagnosis of EIB was 61% (95% CI 50–72%). The negative predictive value was 60% (95% CI 42–76%). The agreement between predicted EIB severity classifications and the validated classifications based on the ECT's, was fair [Kappa = 0.36 (95% CI 0.23–0.48)]. The correlation between predicted EIB severity scored on a continuous rating scale and fall in FEV1 after exercise was weak (rs = 0.39, p < 0.001). Independent predictive variables for fall in FEV1 were wheezing (−11%), supraclavicular retractions (−8.4%) and a prolonged expiratory phase (−8.8%).Conclusion: The ability of pediatricians to assess EIB from post-exercise videos is fair at best, implicating that standardized ECT's are still vital in the assessment of EIB.

EXERCISE INDUCED BRONCHOCONSTRICTION IN MEDICAL STUDENTS

INTRODUCTION: Exercise induced bronchoconstriction (EIB) is transient narrowing of lower respiratory tract airways after exercise. It affects about 5 to 20 % of healthy individuals and 80% of Asthmatics. Obesity has been considered as one of the risk factor to the development of EIB. Symptoms of EIB are nonspecific and can be seen in a variety of disorders and studies have shown a lack of diagnosis specificity and sensitivity based on symptoms. AIM: The aim of this study was to evaluate frequency of EIB in Medical students of Govt. Medical College Miraj. We also tried to find out association of body mass index (BMI) with EIB. We also tried to find out correlation of subjective feeling of breathlessness (symptom of EIB) with actual findings of spirometry tests used to asses EIB. METHOD: This cross-sectional observational study was conducted on 80 male medical students. Exercise challenge test was conducted for participants. Pre and post-test values of Forced expiratory volume in one second (FEV1) and Peak expiratory flow rate (PEFR) were compared and students with ≥ 10% decrease in post-test FEV1 &amp; PEFR were considered positive cases of exercise induced bronchoconstriction. Statistical analysis was done by using software, IBM-SPSS VER 20. RESULT:In our study frequency of EIB in medical students was 6.4%. Decrease in post-test FEV1 and PEFR values were statistically significant with Pvalue &lt; 0.001. Our findings show that there was no association between BMI and EIB. Our study results also reveal strong correlation between subjective feeling of breathlessness measured in terms of visual analogue scale (VAS) and objective spirometry tests used to assess EIB. CONCLUSION: EIB is one of the major problems to be addressed as increasing frequency of EIB in healthy population could pose a threat when people attempt exercise training for their health benefits. Proper care with physician's consultation can minimize undue risks associated with EIB in healthy people.

EXERCISE INDUCED BRONCHOCONSTRICTION IN MEDICAL STUDENTS

INTRODUCTION: Exercise induced bronchoconstriction (EIB) is transient narrowing of lower respiratory tract airways after exercise. It affects about 5 to 20 % of healthy individuals and 80% of Asthmatics. Obesity has been considered as one of the risk factor to the development of EIB. Symptoms of EIB are nonspecific and can be seen in a variety of disorders and studies have shown a lack of diagnosis specificity and sensitivity based on symptoms. AIM: The aim of this study was to evaluate frequency of EIB in Medical students of Govt. Medical College Miraj. We also tried to find out association of body mass index (BMI) with EIB. We also tried to find out correlation of subjective feeling of breathlessness (symptom of EIB) with actual findings of spirometry tests used to asses EIB. METHOD: This cross-sectional observational study was conducted on 80 male medical students. Exercise challenge test was conducted for participants. Pre and post-test values of Forced expiratory volume in one second (FEV1) and Peak expiratory flow rate (PEFR) were compared and students with ≥ 10% decrease in post-test FEV1 &amp; PEFR were considered positive cases of exercise induced bronchoconstriction. Statistical analysis was done by using software, IBM-SPSS VER 20. RESULT:In our study frequency of EIB in medical students was 6.4%. Decrease in post-test FEV1 and PEFR values were statistically significant with Pvalue &lt; 0.001. Our findings show that there was no association between BMI and EIB. Our study results also reveal strong correlation between subjective feeling of breathlessness measured in terms of visual analogue scale (VAS) and objective spirometry tests used to assess EIB. CONCLUSION: EIB is one of the major problems to be addressed as increasing frequency of EIB in healthy population could pose a threat when people attempt exercise training for their health benefits. Proper care with physician's consultation can minimize undue risks associated with EIB in healthy people.

Perception of Exercise-Induced Bronchoconstriction in College Athletes.

Exercise-induced bronchoconstriction (EIB) can lead to long-term respiratory illness and even death. EIB prevalence rates are both high and variable in college athletes. Also, prevalence rates may be underestimated due to ineffective screening. The purpose of this study is to investigate the prevalence of EIB and the perceived impact of EIB in college athletes via a self-report questionnaire. A self-report EIB questionnaire was administered to college athletes on 8 different sports teams. Information collected was used to identify athletes who self-reported: (1) a history of EIB and/or asthma, (2) respiratory symptoms during exercise, (3) medication use, and (4) concern about EIB. Results showed that 56 of 196 athletes (28.6%) self-reported a history of EIB or asthma. Over half (52%) reported a history of EIB/asthma or current EIB symptoms. Forty-six of the 140 athletes (32.9%) who did not report a history of EIB or asthma indicated symptoms of EIB during sports, training, or exercise. Fourteen of 56 athletes (25%) self-reporting a history of EIB or asthma did not report the use of a respiratory medication. Nineteen of 196 athletes (9.7%) reported being concerned that EIB was adversely affecting their sports performance. College athletes self-report a high prevalence of EIB or asthma. Although college athletes may not report a history of EIB or asthma, they indicate symptoms of EIB. A majority of athletes reported a history or current symptoms related to EIB or asthma. Many athletes with a history of EIB or asthma are not taking any asthma medication. Last, athletes report concern about EIB adversely affecting their sports performance. More work is needed using a combination of a screening questionnaire and standardized EIB testing to develop a validated tool for accurately screening and diagnosing EIB in college athletes.

Cytokine profiling in exhaled breath condensate after exercise challenge in asthmatic children with post-exercise symptoms.

IntroductionMarkers of exhaled breath condensate (EBC) correlate with lung function impairment, airway remodeling and different aspects of the disease such as exercise-induced bronchoconstriction (EIB). Aim of the study was to determine the cytokine profile in EBC of children with asthma after an exercise treadmill challenge in order to obtain clinically useful information about mechanisms of EIB; also, to assess correlations between cytokine concentrations in EBC and clinical characteristics of the patients.Material and methodsThe study population consisted of 25 randomly selected children, aged 8 to 19 years, with asthma and EIB symptoms despite the use of control medications. Patients on the day of the study visit underwent fractional exhaled nitric oxide measurement (FeNO) and baseline spirometry, performed an exercise treadmill challenge (ETC), and EBC samples were obtained at the end of the ETC.ResultsIn asthmatic children with positive ETC, monocyte hemotactic protein-1 (MCP-1) and IL-16 adjusted to pre-EBC forced expiratory volume in 1 s (FEV1) were significantly higher compared to children with negative ETC (p = 0.022 and p = 0.017 respectively). After adjustment to pre-EBC FEV1 other cytokines (IL-4, IL-5, IL-6, IL-8, MIG, TNF-α) were not related to post-exercise changes in FEV1.ConclusionsWe observed a specific inflammatory profile in the airways of asthmatic children with bronchoconstriction induced by exercise. The concentration of cytokines in EBC depended on the post-exercise decrease in FEV1, which was measured by the area under the curve (AUC). MCP-1 and IL-16, adjusted to pre-EBC FEV1, were significantly higher in children with a positive exercise challenge compared to those with a negative one.

Exercise-Induced Bronchospasm In Adolescents: Characteristics Of Lung Function and Accuracy Of Symptoms

Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs after exercises; although evidence-based documents exist to guide health care providers with regard to its diagnosis, it is often in medical practice considering only the symptoms, without a confirmatory test, to determine BIE. The aim of this study is to estimate the prevalence of EIB among adolescent students with and without reported asthma and to evaluate the accuracy of symptoms in detection of EIB. Cross-sectional study with 220 adolescents students from 12 to 14 years. A bronchial provocation exercise-induced test was performed and symptoms questionnaire for asthma and EIB was applied. Besides to estimate the prevalence of EIB and accuracy of symptoms to detect BIE, we compared the fall in FEV1 between asthmatics and non-asthmatics. The significance level was 95%. The prevalence of EIB was 19.1% (n = 42) (95% CI 14.0 to 24.0) and asthma was 18.6% (n= 41). Asthmatics with EIB showed significant decrease in FEV1 (p = 0.000) at 5 minutes post-exercise, showing increased earliness and severity of EIB when associated with asthma. Diagnosis of EIB by symptoms allocated 62 students. However, after bronchial provocation test, only 14 (22.6%) had a decrease > 10% in FEV1 (sensitivity 33%, specificity 73%, PPV: 22%, and NPV: 82%). There was synergism between EIB and asthma in reducing FEV1 post-test. Suggestive symptoms of EIB have low accuracy, with unacceptable false positives and negatives values for diagnosis. The clinical relevance is to discourage doctors in diagnosing EIB based only by symptoms.

A Review of Guidelines and Pharmacologic Options for Asthma Treatment, with a Focus on Exercise-Induced Bronchoconstriction

Asthma affects millions of individuals worldwide. Exercise-induced bronchoconstriction is common in patients diagnosed with asthma, but may also occur in patients without chronic asthma. Patients with isolated exercise-induced bronchoconstriction may require pretreatment with inhaled short-acting β-agonists prior to exercise. Patients diagnosed with asthma can achieve good control of the symptoms of exercise-induced bronchoconstriction with appropriate treatment of underlying chronic asthma. Current guidelines suggest staging patients with asthma based on severity of symptoms and initiating therapy according to their stage. Pharmacotherapy for asthma management consists of both quick-relief medications (short-acting β-agonists) as well as maintenance, or long-term control, medications (inhaled corticosteroids, long-acting β-agonists, leukotriene receptor antagonists, cromolyn, and theophylline).

An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma. To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting β(2)-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β(2)-agonist before exercise, strong recommendations were made for a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise. The recommendations in this Guideline reflect the currently available evidence. New clinical research data will necessitate a revision and update in the future.

Screening for Exercise-Induced Bronchoconstriction in College Athletes

Objective. Previous studies have reported that the prevalence of exercise-induced bronchoconstriction (EIB) in athletes is higher than that of the general population. There is increasing evidence that athletes fail to recognize and report symptoms of EIB. As a result, there has been debate whether athletes should be screened for EIB, particularly in high-risk sports. Methods. We prospectively studied 144 athletes from six different varsity sports at a large National Collegiate Athletic Association Division I collegiate athletic program. Baseline demographics and medical history were obtained and the presence of asthma symptoms during exercise was documented. Each athlete subsequently underwent a eucapnic voluntary hyperventilation (EVH) test to document the presence of EIB. Exhaled nitric oxide (eNO) quantification was performed immediately before EVH testing. EIB was defined as a ≥10% decline in forced expiratory volume in 1 second compared with baseline. Results. Only 4 of 144 (2.7%) athletes were EIB-positive after EVH testing. The presence of symptoms was not predictive of EIB as only 2 of the 64 symptomatic athletes (3%) were EIB-positive based on EVH testing. Two of the four athletes who were found to be EIB-positive denied such symptoms. The mean baseline eNO in the four EIB-positive athletes was 13.25 parts per billion (ppb) and 24.5 ppb in the EIB-negative athletes. Conclusions. Our data argue that screening for EIB is not recommended given the surprisingly low prevalence of EIB in the population we studied. In addition, the presence or absence of symptoms was not predictive of EIB and eNO testing was not effective in predicting EIB.

Usefulness of Selected Tests in the Diagnosis of Exercise-Induced Bronchoconstriction

Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV(1) ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB. Forty two subjects were allocated to 3 groups: A - 19 steroid naive asthma patients; D - 11 no-asthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K - 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5'-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV(1) criterion. The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2. Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exercise-induced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.

A rat model of exercise-induced asthma: a nonspecific response to a specific immunogen.

Exercise-induced bronchoconstriction (EIB) is common; however, key aspects of its pathogenesis are still unclear. We investigated the feasibility of adapting an established animal model of asthma to investigate the earliest stages of EIB. The hypothesis was that a single exposure to a normally innocuous, and brief, exercise challenge could trigger EIB symptoms in rats previously sensitized to ovalbumin (OVA) but otherwise unchallenged. Brown-Norway rats were sensitized by intraperitoneal injection of OVA at 0 and 2 wk. At week 3, animals were exposed to either aerosolized OVA (SS) or exercise (EXS). A trained, blinded, clinical observer graded EIB by respiratory sounds. Plasma and lung cytokine levels were analyzed. No control rats with or without exercise (EX, CON) showed evidence of EIB. Eighty percent of the SS group demonstrated abnormal breath sounds upon exposure to aerosolized OVA. Approximately 30% of EXS rats sensitized to OVA but exposed only to exercise had abnormal breath sounds. Lung tissue levels of TNF-α, IL-1α, growth-related oncogene/keratinocyte/chemoattractant, and IFN-γ were significantly higher (P < 0.001) in the SS group, relative to all other groups. Changes in most of these cytokines were not notable in the EXS rats, suggesting a different mechanism of EIB. Remarkably, IFN-γ, but not the other cytokines measured, was significantly elevated following brief exercise in both sensitized and unsensitized rats. Exercise led to detectable breathing sound abnormalities in sensitized rats, but less severe than those observed following classical OVA challenge. Precisely how this immune crossover occurs is not known, but this model may be useful in elucidating essential mechanisms of EIB.

Imitators of exercise-induced bronchoconstriction

Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.

Exercise-Induced Bronchoconstriction in Asthmatic Children

The aim of this article is to critically review the efficacy and safety data from randomized controlled trials (RCTs) using inhaled corticosteroids (ICSs), long- or short-acting beta(2)-adrenoceptor agonists (LABAs, SABAs), parasympatholytics and oral leukotriene receptor antagonists in the management of exercise-induced bronchoconstriction (EIB) in children with persistent asthma (EIA). The studies with sufficient information on patient characteristics and outcomes were chosen using a MEDLINE search. Results from the individual searches were combined and repeated. Studies were also found by reviewing the reference lists of the articles not included in this review. Studies focusing solely on individuals with asthma and other allergic co-morbidities (i.e. a degree of bronchial reversibility) were considered in this review. To make the paper evidence-based, the design and the quality of different studies were assessed employing the Sign criteria (evidence level [EL] and grades of recommendation [GR]). No additional statistical analyses were performed. Most of studies included paediatric patients with underlying EIA. We need to distinguish children with recurrent asthma symptoms in whom EIB is also present (patients with EIA) from asthmatic subjects whose symptoms appear only as a result of exercise (patients with EIB). Further controller treatment is indicated in patients with EIA and further reliever treatment in patients with EIB. ICSs are the first-choice controller drugs for EIA in children with persistent asthma (Sign grade of recommendation [GR]:A). In children with EIA without complete control with ICSs, SABAs (GR:A), leukotriene receptor antagonists (LTRAs) [GR:A] or LABAs (GR:A) may be added to gain control. Treatment with relievers such as SABAs (GR:A), parasympatholytics (GR:B) or, eventually, LABAs (GR:A), administered 10-15 minutes before exercise is the most preferable method of preventing EIB symptoms in children; however, not as monotherapy in children with EIA. The disadvantages and controversy relating to inhaled beta(2)-adrenoceptor agonist use lie in the development of tolerance to their effect when they are used on a regular basis, and the possibility of a resulting underuse of ICSs in patients with EIA. Researchers and guidelines recommend that if any patient requires treatment with a beta(2)-adrenoceptor agonist more than twice weekly, a low dose of ICSs should be administered. Inhaled parasympatholytics may be effective as preventive relievers in some children with EIB or EIA, especially among those with increased vagal activity. LTRAs have a well balanced efficacy-safety profile in preventing the occurrence of EIB symptoms in children. Compared with LABAs, LTRAs produce persistent attenuation of EIB and possess an additional effect with rescue SABA therapy in persistent asthmatic patients with EIA. A disadvantage of LTRAs is a non-response phenomenon. There are still insufficient data on the efficacy-safety profiles of ICS/LABA combination drugs in the treatment of EIA in children to recommend this treatment without caution. Safety profiles of inhaled SABAs, anticholinergics and montelukast in approved dosages seem sufficient enough to recommend use of these drugs in the prevention of EIB symptoms in children. Many researchers agree that treatment of EIA in children should always be individualized.

Cardiopulmonary Exercise Testing in Children and Adolescents with Asthma Who Report Symptoms of Exercise-Induced Bronchoconstriction

Patients with asthma often report symptoms of exercise-induced bronchoconstriction. We performed cardiopulmonary exercise testing to establish the cause of exercise limitation in patients with asthma, under treatment, who reported symptoms of exercise-induced bronchoconstriction. Ten of the 42 patients meeting criteria for inclusion in our study (24%) developed exercise-induced bronchoconstriction. Exercise limitation without exercise-induced bronchoconstriction was found in both obese and non-obese patients, suggesting that poor fitness is a problem independent of body habitus. Including cardiopulmonary exercise testing in the management of children with suspected exercise-induced bronchoconstriction would provide a better understanding of the etiology of their symptoms and facilitate more appropriate treatment.

High-Intensity Physical Warm-Upanda Short-Acting B2-Agoniston Exercise-Induced Bronchoconstriction

1559 Approximately 3–10% of the US population suffer from exercise-induced bronchoconstriction (EIB). It is suggested within the literature that the symptoms of EIB may be alleviated by completing a physical warm-up prior to exercise. PURPOSE: To determine the effects of a pre-exercise high-intensity physical warm-up and a short-acting B2-agonist on the severity of EIB. METHODS: Seven participants (3 male, 4 female) were included in the study based upon an initial diagnosis of EIB and performed an 8-min exercise challenge at 85–90% of age-predicted maximal heart rate on four separate occasions (C, WU, WU I, I WUI). WUI C was the initial diagnosis of EIB and incorporated an assessment of pulmonary function pre- and post-exercise (at 1,5,10 & 15 minutes), with a reduction in post-exercise forced expiratory volume in 1 sec (FEV1) >10% being diagnostic. C also acted as a baseline measure, following which the participants were then randomly assigned to the order of experimental conditions. WU consisted of the exercise challenge, preceded by a pre-exercise warm-up [8×30 sec runs (running intensity of 15kmh−1 for males & 12kmh−1 for females) with 45 sec rest intervals], I consisted of the exercise challenge, preceded by the inhalation of a short-acting B2-agonist (salbutamol, 200μg), and WUI consisted of the exercise challenge, preceded by a combination of both. Data was analyzed using both dependant T-tests and repeated measures ANOVA. RESULTS: No changes were seen in pre-exercise pulmonary function values across the conditions (p>0.05) while the decrement in pulmonary function post-exercise was alleviated across all tests when compared to the initial baseline (p<0.05). The WU condition showed a drop of only 4 ± 3% (below diagnostic threshold) while the short-acting B2-agonist showed an increase in FEV1 above initial baseline values (6 ± 6%). However the greatest change in FEV1 was seen when the WU and I trials were combined (WUI) with a 13 ± 4% increase above initial WUI baseline values. Similar trends in pulmonary function were demonstrated in FVC, PEFR, and FEF25–75%. CONCLUSION: While a pre-exercise warm-up alleviates EIB, the combination of a pre-exercise warm-up and a short-acting B2-agonist further enhances FEV1 above baseline levels, and may prove beneficial to athletes with EIB.

EXERCISE-INDUCED BRONCHOCONSTRICTION IN THE ICE RINK

Exercise-induced bronchoconstriction (EIB) is alarmingly high among ice arena athletes and may be related to high exercise ventilation rates of cold, dry air and/or rink air pollutants. Previous observations of this population demonstrate postexercise mid-expiratory flow rates (FEF25-75) are more impaired than other pulmonary function (PF) measurements, suggesting that postexercise FEF25-75 may be useful in identifying peripheral airway hyperreactivity. However, resting PFs of skaters have not been fully evaluated. PURPOSE To determine if resting PFs are useful in identifying airway dysfunction in ice rink athletes. METHODS National Team female ice hockey players (N = 44) served as subjects and were grouped according to observed EIB symptoms and medical history as symptomatic (S; N = 17) or asymptomatic (A; N = 27). Resting, baseline PFs were obtained for all subjects and raw data were converted to percent of age, height and gender based predicted values. RESULTS Baseline FEV1, FEF25-75, and FEV1/FVC were significanly different between S and A (102 ± 13 vs. 118 ± 15, 75 ± 22 vs. 119 ± 24, and 78 ± 8 vs. 88 ± 4, respectively; p < 0.05); FVC and PEF were not different. Within S, FEV1 was different than FEF25-75 (p < 0.05); no other within group differences were identified. Ten S athletes had below normal FEV1/FVC; Nine had below normal FEF25-75. CONCLUSION FEV1/FVC and FEF25-75 obtained from baseline spirometry may be diagnostic of airway dysfunction. This data suggests the presence of peripheral airway inflammation in S ice arena athletes, which may be caused by chronic exposure to cold, dry air and/or internal combustion pollutants emitted from ice resurfacing machines. Supported by Marywood University and the United States Olympic Committe.