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You Are Here: AHRQ Home > Clinical Information > EPC Evidence Reports > Topics In Progress > Exercise-induced Bronchoconstriction and Asthma

Exercise-induced Bronchoconstriction and Asthma

Expected Release Date: late 2009

Key Questions

Physical exercise can be followed by clinical signs and symptoms of an acute asthmatic attack due to airway narrowing. This phenomenon is known as exercise induced asthma (EIA) or exercise induced bronchoconstriction (EIB). EIA is defined as airway obstruction following exercise in a patient who has co-existent asthma; EIB is defined as airway obstruction following exercise in a patient without the presence of co-existent asthma.1

The evidence report on EIB and EIA will include a total of 12 individual systematic reviews.

Diagnosis

The University of Alberta Evidence-based Practice Center (UAEPC) will assume that a standardized exercise challenge test with a drop in FEV1 [forced expiratory volume in 1 second] >10% from baseline represents a reference standard for the diagnosis of EIB/EIA. We will review and discuss this criterion in the background section of the report.

The questions for the diagnosis section of the evidence report include:

  1. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of a self-reported history/symptoms diary (test) for diagnosing EIB/EIA (outcome) compared to standardized exercise challenges (reference standard).
  2. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of a methacholine challenge test (test) for diagnosing EIB/EIA (outcome) compared to standardized exercise challenges (reference standard).
  3. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of sport/venue-specific exercise challenges (test) for diagnosing EIB/EIA (outcome) compared to standardized exercise challenges (reference standard).
  4. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of a eucapnic voluntary hyperphnea (EVH) for diagnosing EIB/EIA compared (outcome) to standardized exercise challenges (reference standard).
  5. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of a Free Running Asthma Screening Test (FRAST) for diagnosing EIA/EIB (outcome) compared to standardized exercise challenges (reference standard).
  6. In patients with suspected EIA/EIB, what are the diagnostic test characteristics of mannitol for diagnosing EIA/EIB (outcome) compared to standardized exercise challenges (reference standard).

We will mention the following rarer diagnostic approaches in the discussion section of the evidence report: cold dry air, AMP [adenosine 5'-monophosphate ], hypertonic saline, and other newer tests, if identified.

Therapy

Since there are many different possible combinations of treatment for EIA/EIB, we have focused the questions using PICO (population, intervention, comparison, outcomes) methodology and have split the questions into pharmacologic and non-pharmacologic treatments. We have specifically not undertaken reviews on rarely studied compounds (e.g., furosemide, heparin); however, these will be mentioned in the general discussion on therapy.

Pharmacologic (Randomized Controlled Trials [RCTs] only)
  1. In patients with confirmed EIA/EIB (population), do patients using short-acting beta-agonists (SABA) and/or long acting beta-agonists (LABA) therapy (treatment) develop tachyphylaxis to treatment and, if so, at what frequency (outcomes), compared to standard comparator treatments and/or placebo (comparison).
  2. 2. In patients with confirmed EIA/EIB (population), does pre-exercise treatment with leukotriene receptor antagonists (LATRA) therapy (treatment) reduce symptoms and prevent a >10% drop in FEV1 (outcomes) compared to no treatment/placebo (comparison).
  3. In patients with confirmed EIA/EIB (population), does pre-exercise treatment with inhaled corticosteroid (ICS) therapy (treatment) reduce symptoms and prevent a >10% drop in FEV1 (outcomes) compared to no treatment/placebo (comparison).
  4. In patients with confirmed EIA/EIB (population), does pre-exercise treatment with mast cell stabilizers (sodium cromoglycate or nedocromil) therapy (treatment) reduce symptoms and prevent a >10% drop in FEV1 (outcomes) compared to no treatment/placebo (comparison).
  5. In patients with confirmed EIA/EIB (population), does pre-exercise treatment with anti-cholinergics (ipratropium) therapy (treatment) reduce symptoms and prevent a >10% drop in FEV1 (outcomes) compared to no treatment/placebo (comparison).

We intend to mention the following rarer treatments in the discussion section: ketotifen (antihistamines), calcium channel blockers, and isoproterenol (not allowed in Olympic athletes).

Non-pharmacologic (RCTs only)
  1. 1. In patients with confirmed EIA/EIB (population), does a refractory period (10-15 min warm up and/or cool down treatment) reduce symptoms and prevent a >10% drop in FEV1 (outcomes) compared to no treatment/placebo (comparison).

We intend to mention the following non-pharmacological approaches to treatment in the discussion section: choose less asthmogenic exercise, masks, nasal breathing, control underlying asthma, avoid certain foods before exercise, environmental control, and allergy control.

Reference

1. Weiler JM, Bonini S, Coifman R, Craig T, Delgado L, Capao-Filipe M, et al. American Academy of Allergy, Asthma & Immunology Work Group Report: Exercise-induced asthma. J Allergy Clin Immunol 2007;119(6):1349-58.

Current as of November 2008

Internet Citation:

Exercise-induced Bronchoconstriction and Asthma, Clinical Focus. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/eibeiatp.htm

 
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