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Exercise-induced bronchoconstriction

Author
Paul M O'Byrne, MB, FRSC
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Robert A Wood, MD
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Exercise-induced bronchoconstriction describes the acute onset of bronchoconstriction occurring during or immediately after exercise. The term "exercise-induced asthma" is often used to describe episodic bronchoconstriction following exercise, but this wording is potentially misleading, since exercise is not an independent risk factor for asthma, but rather a trigger of bronchoconstriction in patients with underlying asthma [1]. In fact, there is some speculation that decreased physical activity is a risk factor for asthma, and that exercise may be helpful in preventing the onset of asthma in children [2]. Thus, the term exercise-induced bronchoconstriction (EIB) is a more accurate reflection of the underlying pathophysiology, and is generally preferred.

The clinical manifestations, diagnosis, and management of exercise-induced bronchoconstriction will be discussed here. The clinical manifestations, evaluation, and management of asthma are reviewed separately. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Diagnosis of asthma in adolescents and adults" and "Pulmonary function testing in asthma" and "Wheezing phenotypes and prediction of asthma in young children" and "An overview of asthma management" and "Asthma in children younger than 12 years: Initiating therapy and monitoring control".)

EPIDEMIOLOGY

The estimated prevalence of exercise-induced bronchoconstriction (EIB) varies from approximately 5 to 20 percent in the general population [3-6]. In comparison, up to 90 percent of patients with symptomatic asthma have some degree of EIB [6]. The magnitude of EIB is most strongly correlated with the underlying degree of airway hyperresponsiveness and the presence of airway inflammation, as measured by the number of airway eosinophils [7,8]. Thus, many patients with mild, episodic asthma characterized by minimally increased airway responsiveness and mild airway inflammation do not experience clinically significant bronchoconstriction even with strenuous exercise.

The prevalence of EIB appears to be higher among elite athletes and has been evaluated in a number of studies [6,9-12]. As an example, in a study of athletes participating in the summer Beijing and Athens Olympic Games, the sports most commonly associated with a Therapeutic Use Exemption for asthma were swimming, cycling, triathlon, pentathlon, and rowing, with prevalences of approximately 18, 12, 13, 7 percent, respectively [9]. In contrast, the prevalence of asthma among athletes in disciplines without endurance demands, such as gymnastics, fencing, and sailing, was less than 5 percent. In a separate study, positive eucapnic hyperventilation was noted in 39 percent of swimmers and 24 percent of winter sport athletes [12].

PATHOGENESIS

Minute ventilation, the volume of air inhaled or exhaled from a person's lungs per minute, rises with exercise. EIB probably results from changes in airway physiology triggered by the large volume of relatively cool, dry air inhaled during vigorous activity [13,14]. This is supported by the finding that EIB is attenuated when the inspired gas is more fully humidified and closer to body temperature [15,16]. The effect of large-volume dry air inhalation on airway surface osmolality may be the primary stimulus responsible for bronchoconstriction [17]. Other relevant observations regarding EIB include the following:

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 28 00:00:00 GMT+00:00 2016.
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