Advances in the diagnosis of exercise-induced bronchoconstriction

Abstract

Exercise-induced bronchoconstriction (EIB) describes the post exercise phenomenon of acute airway narrowing in association with physical activity. A high prevalence of EIB is reported in both athletic and recreationally active populations. Without treatment, EIB has the potential to impact upon both health and performance. It is now acknowledged that clinical assessment alone is insufficient as a sole means of diagnosing airway dysfunction due to the poor predictive value of symptoms. Furthermore, a broad differential diagnosis has been established for EIB, prompting the requirement of objective evidence of airway narrowing to secure an accurate diagnosis. This article provides an appraisal of recent advances in available methodologies, with the principle aim of optimising diagnostic assessment, treatment and overall clinical care.

Keywords::

• airway dysfunction
• airway-hyperresponsiveness
• asthma
• athletes
• diagnosis
• exercise-induced bronchoconstriction

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Self-reported respiratory symptoms (e.g., wheezing, dyspnea, coughing) correlate poorly with objective evidence of airway narrowing. Similarly resting spirometry is poorly prognostic of exercise-induced bronchoconstriction (EIB).

• There is a high prevalence of airway dysfunction reported in both elite athletic and recreationally active populations.

• Misdiagnosis of EIB has two main consequences: first, health (e.g., unnecessary medication); and second, athletic performance (e.g., reduced ability).

• An accurate diagnosis of EIB should be established through changes in lung function following a provocative stimulus to the distal airways, rather than based on clinical features alone.

• Eucapnic voluntary hyperpnea is currently the recommended challenge to secure an accurate diagnosis of EIB in athletes. However, in patients with severe or poorly controlled asthma direct bronchoprovation testing that is progressive in nature (i.e., dry powder mannitol challenge) is advised.

• Regular surveillance and/or monitoring of lung function are recommended for athletes with EIB in order to optimize treatment. Additional parameters (e.g., inflammatory biomarkers) may also be useful for this purpose.

• A broad differential diagnosis exists for respiratory symptoms in association with exercise including anemia, physical deconditioning, cardiac and other pulmonary diseases (e.g., exercise-induced laryngeal obstruction).

Notes