Clinical Review

Exercise induced bronchoconstriction in adults: evidence based diagnosis and management

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.h6951 (Published 13 January 2016) Cite this as: BMJ 2016;352:h6951
  1. James M Smoliga, associate professor of physiology1,
  2. Pnina Weiss, associate professor of pediatrics (respiratory)2,
  3. Kenneth W Rundell, adjunct associate professor3
  1. 1Department of Physical Therapy, High Point University, High Point, NC 27268, USA
  2. 2Pediatric Respiratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
  3. 3The Commonwealth Medical College, Scranton, PA, USA
  1. Correspondence to: J M Smoliga jsmoliga{at}highpoint.edu

What you need to know

  • Exercise induced bronchoconstriction (EIB) is most common in individuals with asthma but also occurs in those without

  • EIB is commonly misdiagnosed because its symptoms (such as shortness of breath, chest tightness, wheezing, and cough) are neither sensitive nor specific

  • EIB is most accurately diagnosed by using spirometry to measure forced expiratory volume in one second (FEV1) before and after a high intensity exercise challenge in dry air or eucapnic voluntary hyperpnoea

  • Short acting β agonists are recommended first line treatment for confirmed EIB, used only “as required” rather than daily to avoid tolerance and potential exacerbations

  • People with EIB symptoms and a negative bronchoprovocation test or with documented EIB and ongoing symptoms despite treatment should have their management and diagnosis reviewed

  • Exercise induced laryngeal obstruction is a relatively common cause of breathlessness in athletes, which may mimic or occur alongside EIB

What is exercise induced bronchoconstriction (EIB)?

EIB is defined as “the transient narrowing of the lower airway following exercise in the presence or absence of clinically recognized asthma.”1 Bronchoconstriction typically develops within 15 minutes after exercise and spontaneously resolves within 60 minutes. After an episode of EIB, there is often a refractory period of about 1-3 hours in which, if exercise is repeated, the bronchoconstriction is less emphasised in 40-50% of patients.2 3 EIB can also occur during exercise.4 5

The term “exercise induced bronchoconstriction” is preferred to that of “exercise induced asthma” since asthma is a chronic condition which is not induced by a single bout of exercise. EIB is more likely in people with asthma, but it also occurs in individuals without asthma.1 6 EIB is characterised by falls in forced expiratory volume in one second (FEV1) after exercise, while in people with asthma there is persistent airway inflammation and recurrent symptoms outside of exercise (that is, …

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