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Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. "Osmotic theory" and "thermal or vascular theory" have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports. [ABSTRACT FROM AUTHOR]

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The prevalence of exercise induced asthma (EIA) in Iran is not known. In the present study the prevalence of EIA among female students of guidance school in the city of Mashhad was evaluated. A total of 1690 female students aged 12-14 years in ten randomly selected schools in north east of Iran (Mashhad) completed an asthma symptoms- specific questionnaire. One hundred forty four randomly selected students including 49 symptomatic and 95 asymptomatic cases participated in a 6 minutes free run test (until reaching 70-75% of MHR (maximum heart rate) for evaluating EIA. Pulmonary function tests (PFT) were measured before (baseline), immediately, 5 minutes and 15 minutes after exercise. The prevalence of asthma symptoms among the studied students was 12.54%. There was not significant difference in any of PFT values between asymptomatic and symptomatic students. The results of exercise test showed that totally 61.22% of symptomatic students responded to exercise test (their post-exercise PFT values decline more than 15%) while only 16.82% of asymptomatic students were responders to exercise (p<0.001). However, in both asymptomatic and symptomatic responder students, all PFT values declined significantly after exercise compared to baseline values (p<0.05 to p<0.001) and there was not any significant difference between two groups. The results showed that although higher number of symptomatic students showed EIA, some asymptomatic students also sowed EIA. [ABSTRACT FROM AUTHOR]

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Objective: Exercise-induced bronchospasm (EIB) is a common condition in elite athletes. The purpose of this study was to evaluate the diagnostic value of self-reported EIB symptoms in children. Methods: In a cross sectional study in 2005, all soccer player boys of 3 football schools of Shahr Rey a town in the south of Tehran, enrolled in this study. All subjects were asked for the presence of four cardinal symptoms of EIB (cough, wheeze, shortness of breath, chest pain/discomfort) during and after exercise. Self reported symptom-based EIB was defined as having at least two out of four symptoms. Findings were compared to spirometric criteria as a gold standard test. Findings: A total of 371 boys were enrolled in this study. The mean age of children was 11.67 ± 1.53 years (range 7-16 years). According to spirometric findings, 74 (19.9 %) subjects had EIB. The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 13.0 % and 89.9 %, respectively. Conclusion: Self-reported symptoms of EIB in children can be useful for epidemiological study. Our results in Iran are comparable with studies in other countries and point to a relatively high prevalence of EIB among athlete children. [ABSTRACT FROM AUTHOR]

Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled β2-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the ‘natural course’ of asthma in athletes by anti-inflammatory treatment. [ABSTRACT FROM AUTHOR]

Exercise-induced asthma, or more appropriately, exercise-induced bronchoconstriction (EIB), occurs in 80 to 90% of individuals with asthma and in approximately 11% of the general population without asthma. EIB is characterised by post-exercise airways obstruction resulting in reductions in forced expiratory volume in 1 second (FEV[sub 1]) of greater than 10% compared with pre-exercise values. The mechanism of EIB remains elusive, although both cooling and drying of airways play prominent roles. Cold, dry inhaled air during exercise or voluntary hyperventilation is the most potent stimulus for EIB. Inflammatory mediators play central roles in causing the post-exercise airways obstruction. Diagnosis of EIB requires the use of an exercise test. The exercise can be a field or laboratory based test, but should be of relatively high intensity (80 to 90% of maximal heart rate) and duration (at lest 5 to 8 minutes). Pre- and post-exercise pulmonary function should be compared, and post exercise pulmonary function determined over 20 to 30 minutes for characterisation of EIB. A pre- to post-exercise drop in FEV[sub 1] of greater than 10% is abnormal. Approaches to treatment of EIB include both nonpharmacological and pharmacological strategies. A light exercise warm up prior to moderate to heavy exercise reduces the severity of EIB. More recently, studies have supported a role for dietary salt as a modifier of the severity of EIB, suggesting that salt restrictive diets should reduce symptoms of EIB. Short acting, inhaled β[sub 2]-agonists constitute the most used prophylactic treatment for EIB. However, antileukotriene agents are emerging as effective, well tolerated, long-term treatments for EIB. [ABSTRACT FROM AUTHOR]

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Drug therapy provides a safe and effective way of controlling asthma in children. The appropriate medications combined with advice regarding modification of trigger factors where possible should allow the asthmatic child a normal lifestyle. The child and the parents need to understand the rationale for treatment, particularly with regard to preventive medications, and education is an important aspect of management. As many children improve with increasing age, treatment should be continually re-assessed with the aim of maintaining the patient on the minimal amount of medication that will keep the asthma under good control. [ABSTRACT FROM AUTHOR]