Synopsis
Recognise the physiology and mimics of exercise-induced bronchoconstriction, confirm it with appropriate objective testing, and preserve safe participation through anti-inflammatory asthma care.
- Exercise-induced bronchoconstriction is a transient fall in expiratory airflow after exertion; it is common in asthma but can occur without otherwise typical chronic asthma.
- Symptoms alone perform poorly: exertional cough, wheeze and breathlessness also arise from inducible laryngeal obstruction, dysfunctional breathing, poor fitness, obesity, cardiac disease and anaemia.
- EIB often peaks shortly after intense exercise, particularly in cold dry air; inspiratory noise and throat tightness at peak exercise favour exercise-induced laryngeal obstruction.
Key red flags
Exercise symptoms accompany night waking, variable daytime symptoms, increasing reliever use, attacks or poor inhaled corticosteroid use. EIB is then a control signal rather than an isolated sporting problem.
Investigation priorities
Identify resting obstruction and broader variable airflow disease.
Management branches
Breathlessness, cough or noisy breathing is repeatedly associated with exercise.
- Describe exact activity, intensity, environment, onset relative to peak effort, inspiratory versus expiratory noise, throat or chest sensation and recovery time.
- Ask about asthma outside exercise, attacks, inhaler use, allergic triggers, food or medicine cofactors, cardiac symptoms and training history.
The person is stable and objective confirmation of EIB will change management.
Key medicines
Budesonide-formoterol anti-inflammatory relieverUse one inhalation as needed from the exact product and strength prescribed for AIR, including pre-exercise use when agreed in the personalised plan.
Inhaled salbutamol before predictable exerciseA licensed adult regimen is 200 micrograms inhaled ten to fifteen minutes before challenge, within a plan that also supplies inhaled corticosteroid treatment.