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Guidelines for Managing Exercise-Induced Bronchoconstriction

Guidelines for Managing Exercise-Induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) describes the acute air­way narrowing that occurs as a result of exercise. The condition occurs in a substantial number of patients with asthma but may also present in those without known asthma. According to current estimates, EIB may affect about 15% to 20% of patients without diagnosed asthma. For Olympic and elite athletes, the prevalence estimates are even higher, ranging between 30% and 70%. Given its high prevalence, evidence-based guidelines for EIB management are of critical importance. In the American Journal of Respiratory & Critical Care Medicine, the American Thoracic Society (ATS) published a clinical practice guideline to help clinicians manage patients with EIB. To develop the guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB. Recommendations were established for the diagnosis and management of EIB as well as its environmental triggers. The document also contains special considerations for managing elite athletes. Diagnosis & Treatment of Exercise-Induced Bronchoconstriction To diagnose EIB, the ATS recommends that clinicians focus their attention on exercise-induced changes in lung function rather than symptoms. Serial measurements of FEV1 after a specific exercise or hyperpnea challenge are preferred. A drop in FEV1 of at least 10% defines EIB. Several effective treatments and preventive measures, both pharmacologic and non-pharmacologic, are available for EIB. It’s strongly recommended that all patients with EIB use an inhaled short-acting β2-agonist about 15 minutes before exercise. For those with persistent symptoms or who use short-acting β2-agonist therapy daily or more frequently, the guidelines strongly recommend using a daily inhaled corticosteroid, a daily leuko­triene receptor antagonist, or a mast cell–stabilizing agent before exercise. The guidelines...
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