ATS publishes clinical practice guidelines on exercise-induced bronchoconstriction
The American Thoracic Society (ATS) released new official clinical practice guidelines on the diagnosis and management of exercise-induced bronchoconstriction (EIB) published in the American Journal of Respiratory and Critical Care Medicine. EIB is the acute airway narrowing that occurs as a result of exercise-induced stress. According to Jonathan Parsons, MD, associate professor of internal medicine and associate director of The Ohio State University Asthma Center and chair of the committee that drafted the statement, "While a large proportion of asthma patients experience exercise-induced respiratory symptoms, EIB also occurs frequently in subjects without asthma." Among asthma suffers EIB is currently unknown, however it is estimated that 20% of those not diagnosed with asthma do suffer from EIB. That number jumps to a range between 30% and 70% for Olympic and elite-level athletes.
Treatment recommendations in the guidelines include use of a short-acting beta-agonist before exercise in all EIB patients. For those patients who continue to have symptoms after beta-agonist treatment, the guidelines recommend use of a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise. Additional recommendations can be found at: http://www.thoracic.org/statements/
Additional recommendations include the use of a progressive warm-up before planned exercise. Avoiding areas with low air circulation, cold dry air, ambient ozone, and airborne particle/allergen matter are also included. Researchers suggest that “these and other environmental factors may contribute to the increased prevalence of EIB seen among competitive ice skaters, skiers, swimmers, and distance runners.” For competitive athletes management is a bit more difficult as many of the treatments used to treat EIB, including beta-agonists, are banned or restricted in competitive athletics. Due to these restrictions, treatment must be tailored according to the guidelines of the governing bodies of these sports. According to lead author Dr. Parsons. "The recommendations in these guidelines synthesize the latest clinical evidence and will help guide the management of EIB in patients with or without asthma and in athletes at all levels of competition."