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Exercise-induced bronchoconstriction

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216:. It is also important to distinguish those who have asthma with exercise worsening, and who consequently will have abnormal testing at rest, from true exercise-induced bronchoconstriction, where there will be normal baseline results. Because of the wide differential diagnosis of exertional respiratory complaints, the diagnosis of exercise-induced bronchoconstriction based on history and self-reported symptoms alone has been shown to be inaccurate and to result in an incorrect diagnosis more than 50% of the time. An important and often overlooked differential diagnosis is 1394: 58: 139:, consistent with an asthma attack. However, many will present with decreased stamina, or difficulty in recovering from exertion compared to team members, or paroxysmal coughing from an irritable airway. Similarly, examination may reveal wheezing and prolonged expiratory phase, or may be quite normal. Consequently, a potential for under-diagnosis exists. Measurement of airflow, such as 171:. Constriction of these small airways then follows, worsening the degree of obstruction to airflow. There is increasing evidence that the smooth muscle that lines the airways becomes progressively more sensitive to changes that occur as a result of injury to the airways from dehydration. The chemical mediators that provoke the muscle spasm appear to arise from 233:
but the distinction is important because without successful treatment of underlying asthma, treatment of an exercise component will likely be unsuccessful. If baseline testing is normal, some form of exercise or pharmacologic stress will be required, either on the sideline or practice venue, or in the laboratory.
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A relatively recent review of the literature has concluded that there is currently insufficient available evidence to conclude that either mannitol inhalation or eucapnic voluntary hyperventilation are suitable alternatives to exercise challenge testing to detect exercise-induced bronchoconstriction
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at rest. In true exercise-induced bronchoconstriction, the results should be within normal limits. Should resting values be abnormal, then asthma, or some other chronic lung condition, is present. There is, of course, no reason why asthma and exercise-induced bronchoconstriction should not co-exist
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by precipitating an attack by "warming up," and then timing competition such that it occurs during the refractory period. Step-wise training works in a similar fashion. Warm up occurs in stages of increasing intensity, using the refractory period generated by each stage to reach a full workload.
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issued the first treatment guidelines for EIB, recommending use of "a short-acting β2-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β2-agonist before exercise, strong recommendations were made for a
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The best treatment is avoidance of conditions predisposing to attacks, when possible. In athletes who wish to continue their sport or do so in adverse conditions, preventive measures include altered training techniques and medications.
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Treadmill or ergometer-based testing in lung function laboratories are effective methods for diagnosing exercise-induced bronchoconstriction, but may result in false negatives if the exercise stimulus is not intense enough.
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can be difficult to diagnose clinically given the lack of specific symptoms and frequent misinterpretation as manifestations of vigorous exercise. There are many mimics that present with similar symptoms, such as
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challenge test, have a lower sensitivity for detection of exercise-induced bronchoconstriction in athletes and are also not a recommended first-line approach in the evaluation of exercise-induced asthma.
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Stickland MK, Rowe BH, Spooner CH, Vandermeer B, Dryden DM (September 2011). "Accuracy of eucapnic hyperpnea or mannitol to diagnose exercise-induced bronchoconstriction: a systematic review".
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such as chest discomfort, breathlessness, and fatigue are often falsely attributed to the individual being out of shape, having asthma, or possessing a hyperreactive airway rather than EIB.
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Muñoz PA, GĂłmez FP, Manrique HA, Roca J, BarberĂ  JA, Young IH, et al. (2008). "Pulmonary gas exchange response to exercise- and mannitol-induced bronchoconstriction in mild asthma".
167:. The resultant inhalation of air that has not been warmed and humidified by the nasal passages seems to generate increased blood flow to the linings of the bronchial tree, resulting in 155:
While the potential triggering events for EIB are well recognized, the underlying pathogenesis is poorly understood. It usually occurs after at least several minutes of vigorous,
2020: 946: 466:. Research by sports scientist John Dickinson found that 70 percent of UK-based members of the British swimming team had some form of asthma, as did a third of 1314:
Philip G, Pearlman DS, Villarán C, et al. (2007). "Single-dose montelukast or salmeterol as protection against exercise-induced bronchoconstriction".
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Brannan JD, Koskela H, Anderson SD, Chew N (1998). "Responsiveness to mannitol in asthmatic subjects with exercise- and hyperventilation-induced asthma".
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Rundell KW, Im J, Mayers LB, Wilber RL, Szmedra L, Schmitz HR (February 2001). "Self-reported symptoms and exercise-induced asthma in the elite athlete".
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Pigakis, Konstantinos M; Stavrou, Vasileios T; Pantazopoulos, Ioannis; Daniil, Zoe; Kontopodi, Aggeliki K; Gourgoulianis, Konstantinos (3 January 2022).
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reported that he suffers from the condition, after being spotted using a nasal inhaler during race. Other athletes with EIB include racing cyclist
220:. The latter can co-exist with EIB and is best differentiated using objective testing and continuous laryngoscopy during exercise (CLE) testing. 1639: 175:. Mouth breathing as a result of decreased nasal breathing also increases lung surface exposure to irritants, pollutants, and allergens, causing 864:
Mannix ET, Manfredi F, Farber MO (1999). "A comparison of two challenge tests for identifying exercise-induced bronchospasm in figure skaters".
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There is no evidence supporting different treatment for EIB in asthmatic athletes and nonathletes. The most common medication used is a
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Field-exercise challenge tests that involve the athlete performing the sport in which they are normally involved and assessing
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inflammation in response to reactive oxygen species formation; research has found that individuals with genetically hindered
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daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise."
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athletes. In the EVH challenge, the patient voluntarily, without exercising, rapidly breathes dry air enriched with 5% CO
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after exercise are helpful if abnormal but have been shown to be less sensitive than eucapnic voluntary hyperventilation.
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losses in the expired air, not matched by metabolic production, that occurs during hyperventilation, and so maintains CO
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rates, which can be done inexpensively on the track or sideline, may prove helpful. In athletes, symptoms of
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taken about 20 minutes before exercise. Some physicians prescribe inhaled anti-inflammatory mists such as
2435: 1218:"An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction" 2621: 582: 2494: 2119: 2093: 1818: 1719: 708:"Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction" 372: 1393: 906: 57: 2270: 2098: 2083: 2076: 1981: 1942: 1889: 1867: 1825: 1753: 1554: 1456: 2249: 1217: 108:) occurs when the airways narrow as a result of exercise. This condition has been referred to as 2398: 2040: 1956: 1831: 969:"American Academy of Allergy, Asthma & Immunology Work Group report: exercise-induced asthma" 2524: 2377: 2338: 2253: 2206: 1905: 1748: 361: 201: 1594: 908: 1786: 1758: 455: 638:
Anderson SD, Kippelen P (March 2005). "Exercise-induced bronchoconstriction: Pathogenesis".
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cyclists, compared to a national asthma rate of eight to ten percent, whilst a study by the
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Parsons JP, Kaeding C, Phillips G, Jarjoura D, Wadley G, Mastronarde JG (September 2007).
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Weiler JM, Bonini S, Coifman R, Craig T, Delgado L, CapĂŁo-Filipe M, et al. (2007).
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Douglas B. McKeag; James L. Moeller; American College of Sports Medicine (3 July 2007).
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Khan, DA (Jan–Feb 2012). "Exercise-induced bronchoconstriction: burden and prevalence".
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activity, which increases oxygen demand to the point where breathing through the nose (
66: 598: 2651: 1895: 1724: 1685: 1617: 1605: 1565: 1382: 1331: 1296: 1237: 1198: 1193: 1176: 1144: 1103: 1060: 1025: 990: 914: 881: 846: 841: 824: 805: 784:"Prevalence of exercise-induced bronchospasm in a cohort of varsity college athletes" 764: 760: 729: 688: 655: 602: 563: 511: 46: 1249: 1072: 1056: 667: 614: 407:, both given two hours before exercise, showing that the drugs had similar benefit. 2594: 2587: 2451: 2372: 2211: 2147: 1996: 1372: 1364: 1323: 1286: 1276: 1229: 1188: 1134: 1095: 1052: 1017: 980: 893: 873: 836: 795: 756: 719: 647: 594: 553: 545: 532:
Parsons JP, Cosmar D, Phillips G, Kaeding C, Best TM, Mastronarde JG (March 2012).
503: 467: 209: 184: 156: 1156: 463: 2722: 2616: 2568: 2456: 2407: 2328: 2244: 2052: 1559: 1430: 1139: 1122: 1021: 800: 783: 549: 459: 396: 384: 357: 164: 160: 1368: 682: 2554: 2216: 2127: 2047: 1857: 1852: 1570: 1351:"Vitamin C may alleviate exercise-induced bronchoconstriction: a meta-analysis" 1233: 1099: 985: 968: 443: 435: 251: 121: 651: 2716: 2646: 2360: 2071: 943:"Eucapnic Voluntary Hyperventilation (EVH) A Test for the Presence of Asthma" 681:
Gerow, M; Bruner, PJ (January 2023). "Exercise-Induced Bronchoconstriction".
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may be useful to relieve respiratory symptoms such as cough during exercise.
411: 274: 877: 724: 707: 116:); however, this term is no longer preferred. While exercise does not cause 2583: 2536: 1921: 1873: 1742: 1386: 1335: 1300: 1241: 1202: 1148: 1107: 1064: 994: 885: 850: 809: 768: 733: 692: 659: 606: 567: 515: 451: 380: 353: 302: 144: 1327: 1029: 325: 2681: 2628: 2611: 2606: 2559: 2514: 2365: 2313: 2280: 2152: 1881: 1813: 1776: 1731: 1666: 1589: 1281: 1121:
Stickland MK, Rowe BH, Spooner CH, Vandermeer B, Dryden DM (March 2012).
400: 180: 51: 1519: 534:"Screening for exercise-induced bronchoconstriction in college athletes" 2601: 2201: 2187: 2162: 2137: 2132: 2066: 1937: 1913: 1862: 1736: 1701: 1676: 404: 229: 176: 1457:"For Olympians and weekend warriors, winter sports can trigger asthma" 2676: 2308: 2177: 2172: 2142: 1693: 1600: 706:
Hallstrand TS, Curtis JR, Koepsell TD, et al. (September 2002).
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inhalation has been recently approved for use in the United States.
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Parsons JP, Hallstrand TS, Mastronarde JG, et al. (May 2013).
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Carlsen KH, Anderson SD, Bjermer L, et al. (April 2008).
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Carlsen KH, Anderson SD, Bjermer L, et al. (April 2008).
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as prophylaxis against exercise-induced bronchoconstriction.
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It might be expected that people with EIB would present with
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are among the many who have done so. Tour de France winner
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American Journal of Respiratory and Critical Care Medicine
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in 2000 found that half of cross-country skiers had EIB.
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For the duration of activity and some time afterwards
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There is conflicting information about the value of
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American Academy of Allergy, Asthma, and Immunology
687:. Treasure Island (FL): StatPearls Publishing LLC. 913:. Lippincott Williams & Wilkins. p. 167. 583:"Exercise-Induced Bronchoconstriction in Athletes" 580: 1265:"Exercise-Induced Bronchospasm in Elite Athletes" 900: 281:for six minutes. The presence of the enriched CO 2714: 637: 581:Parsons JP, Mastronarde JG (24 December 2015). 187:are likely at a higher risk of developing EIB. 1633: 261:Eucapnic voluntary hyperventilation challenge 218:exercise-induced laryngeal obstruction (EILO) 1426:"Why do so many elite athletes have asthma?" 1307: 1036: 960: 857: 1488:"Tips to Remember: Exercise-induced asthma" 1001: 680: 245: 1640: 1626: 1342: 316:and that additional research is required. 56: 2240:Combined pulmonary fibrosis and emphysema 1376: 1290: 1280: 1192: 1138: 984: 840: 799: 723: 557: 527: 525: 421: 1419: 1417: 301:Medication challenge tests, such as the 71:Shortness of breath on vigorous exercise 2264:Allergic bronchopulmonary aspergillosis 1454: 1209: 1170: 1168: 1166: 414:of preliminary research indicated that 296: 14: 2715: 1450: 1448: 1423: 1348: 633: 631: 522: 1621: 1414: 940: 1455:Gardner, Amanda (17 February 2010). 1163: 493: 489: 487: 228:Objective testing should begin with 102:Exercise-induced bronchoconstriction 33:Exercise-induced Bronchoconstriction 2697:Idiopathic pulmonary haemosiderosis 1505:Fact sheet: Exercise-induced asthma 1445: 910:ACSM's Primary Care Sports Medicine 674: 628: 271:eucapnic voluntary hyperventilation 236: 95:Moderate to high intensity exercise 24: 2286:Vaping-associated pulmonary injury 1649:Diseases of the respiratory system 816: 640:Current Allergy and Asthma Reports 25: 2749: 1480: 484: 1392: 1194:10.1111/j.1398-9995.2008.01663.x 842:10.1111/j.1398-9995.2008.01662.x 761:10.1097/00005768-200102000-00006 1424:Walker, Peter (29 April 2016). 1400: 1256: 1114: 1079: 1057:10.1152/japplphysiol.00108.2008 934: 472:United States Olympic Committee 446:, and American football player 267:International Olympic Committee 214:gastroesophageal reflux disease 2702:Pulmonary alveolar proteinosis 775: 740: 699: 496:Allergy and Asthma Proceedings 13: 1: 2276:Idiopathic pulmonary fibrosis 599:10.1016/S0012-3692(15)49641-2 477: 347: 223: 2259:Respiratory hypersensitivity 2197:Hypersensitivity pneumonitis 1140:10.1249/MSS.0b013e31822fb73a 1022:10.1164/ajrccm.158.4.9802087 801:10.1249/mss.0b013e3180986e45 550:10.3109/02770903.2011.652329 368:have also proven effective. 330: 319: 190: 7: 2168:Coalworker's pneumoconiosis 1369:10.1136/bmjopen-2012-002416 390: 339:Some take advantage of the 10: 2754: 2021:Acute exacerbation of COPD 1234:10.1164/rccm.201303-0437ST 1100:10.1016/j.anai.2011.06.013 1088:Ann Allergy Asthma Immunol 986:10.1016/j.jaci.2007.02.041 323: 163:) must be supplemented by 2664: 2637: 2567: 2553: 2507: 2465: 2444: 2418: 2321: 2307: 2298: 2227: 2112: 2092: 1975: 1955: 1795: 1675: 1655: 1580: 1513: 1349:Hemilä, H (7 June 2013). 1010:Am J Respir Crit Care Med 652:10.1007/s11882-005-0084-y 442:, baseball Hall of Famer 373:American Thoracic Society 133:elevated respiratory rate 91: 83: 75: 65: 45: 37: 32: 2084:Diffuse panbronchiolitis 2077:Bronchiolitis obliterans 1943:Laryngotracheal stenosis 1890:Laryngopharyngeal reflux 1868:Laryngopharyngeal reflux 1826:Laryngopharyngeal reflux 1754:Nasal septum perforation 508:10.2500/aap.2012.33.3507 462:and cross-country skier 326:Asthma § Management 246:Field-exercise challenge 150: 1832:Retropharyngeal abscess 878:10.1378/chest.115.3.649 725:10.1067/mpd.2002.125729 684:Exercise-Induced Asthma 362:leukotriene antagonists 110:exercise-induced asthma 18:Exercise-induced asthma 2525:Pulmonary hypertension 2254:Eosinophilic pneumonia 1906:Vocal cord dysfunction 1749:Nasal septum deviation 973:J Allergy Clin Immunol 422:Prevalence in athletes 285:compensates for the CO 202:vocal cord dysfunction 183:counteraction of this 120:, it is frequently an 2652:Mediastinal emphysema 2431:Healthcare-associated 2361:Legionnaires' disease 1787:Peritonsillar abscess 1759:Nasal septal hematoma 1328:10.1378/chest.07-0550 438:, Olympic track star 366:mast cell stabilizers 324:Further information: 2399:Mendelson's syndrome 2271:Hamman–Rich syndrome 1282:10.7759/cureus.20898 1127:Med Sci Sports Exerc 941:Rosenthal, Richard. 788:Med Sci Sports Exerc 749:Med Sci Sports Exerc 440:Jackie Joyner-Kersee 297:Medication challenge 141:peak expiratory flow 2738:Respiratory therapy 2728:Exercise physiology 2672:Respiratory failure 2639:Mediastinal disease 2207:Bird fancier's lung 1782:Adenoid hypertrophy 206:cardiac arrhythmias 197:bronchoconstriction 129:shortness of breath 2577:Pleuritis/pleurisy 2530:Pulmonary embolism 2426:Community-acquired 2351:Atypical bacterial 2250:Löffler's syndrome 2031:Status asthmaticus 2016:Chronic bronchitis 1901:Vocal fold paresis 1715:Vasomotor rhinitis 1581:External resources 458:, distance runner 293:levels at normal. 79:Rapid, on exercise 2710: 2709: 2660: 2659: 2617:Empyema/pyothorax 2549: 2548: 2545: 2544: 2503: 2502: 2436:Hospital-acquired 2294: 2293: 2158:Caplan's syndrome 1951: 1950: 1896:Vocal fold nodule 1720:Atrophic rhinitis 1615: 1614: 920:978-0-7817-7028-6 426:Olympic swimmers 371:In May 2013, the 341:refractory period 195:Exercise-induced 99: 98: 27:Medical condition 16:(Redirected from 2745: 2595:Pleural effusion 2588:Hemopneumothorax 2565: 2564: 2319: 2318: 2305: 2304: 2148:Bauxite fibrosis 2113:External agents/ 2110: 2109: 2041:Exercise-induced 1997:Acute bronchitis 1973: 1972: 1673: 1672: 1642: 1635: 1628: 1619: 1618: 1511: 1510: 1501: 1499: 1498: 1474: 1473: 1471: 1469: 1452: 1443: 1442: 1440: 1438: 1421: 1412: 1411: 1404: 1398: 1397: 1396: 1390: 1380: 1346: 1340: 1339: 1311: 1305: 1304: 1294: 1284: 1260: 1254: 1253: 1213: 1207: 1206: 1196: 1172: 1161: 1160: 1142: 1118: 1112: 1111: 1083: 1077: 1076: 1040: 1034: 1033: 1005: 999: 998: 988: 964: 958: 957: 955: 954: 945:. 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Index

Exercise-induced asthma
Specialty
Pulmonology
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Symptoms
asthma
asthma trigger
shortness of breath
elevated respiratory rate
wheezing
peak expiratory flow
bronchospasm
aerobic
nasal breathing
mouth breathing
edema
mast cells
neutrophilic
glutathione
oxidative stress
bronchoconstriction
vocal cord dysfunction
cardiac arrhythmias
cardiomyopathies
gastroesophageal reflux disease
exercise-induced laryngeal obstruction (EILO)
spirometry
FEV1
International Olympic Committee
eucapnic voluntary hyperventilation

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