Management of exercise-induced bronchoconstriction (EIB)

Clinical problem	Intervention	Comments
All patients with EIB	Educate about features of exercise that are likely to provoke EIB (eg, effect of temperature, dry air, intensity of exertion, allergens, pollution) and measures for mitigation
	Educate about use of SABA to treat EIB symptoms (eg, albuterol 2 puffs)
	Educate about use of SABA or other agent to prevent EIB
	Advise caution about vigorous exercise when asthma is poorly controlled
Patients intolerant of SABA	Try 1 puff of albuterol instead of 2	May not provide adequate prevention of EIB symptoms.
	Review inhaler technique and consider use of spacer/chamber
	Improve general control of asthma (eg, with inhaled glucocorticoid) to reduce need for prophylaxis	If asthma not well controlled (based on frequency/severity of symptoms or need for rescue inhaler, low peak flow or FEV₁), add inhaled glucocorticoid. If asthma is otherwise well controlled, try alternate preventive agents.
	Try alternate SABA (eg, levalbuterol)^*	Try levalbuterol if above interventions are unsuccessful and levalbuterol is available. Levalbuterol can also be used for breakthrough symptoms. May not completely eliminate adverse effects of SABA.
	Try regular use of LTRA^*¶Δ	LTRA may be more effective in children than adults.
	Try ipratropium 2 puffs, 20 to 30 minutes prior to exercise^*Δ
	Substitute cromolyn or nedocromil (where available) for SABA for prophylaxis^*Δ
EIB refractory to SABA	Add regular use of LTRA
	Improve general control of asthma (eg, with inhaled glucocorticoid)
	Use cromoglycate with SABA as prophylaxis (where available)
	Reassess diagnosis
Patients who exercise for more than 3 hours or more than once per day	Avoid LABA monotherapy or daily use of SABA	Tachyphylaxis may occur with daily SABA or LABA.
	Try LTRA	May be more effective for prevention of EIB in children than adults.
	Improve general control of asthma (eg, with inhaled glucocorticoid)
Patients who exercise in extreme conditions (eg, high intensity or in dry, cold air)	Try methods for mitigation (eg, warm-up, scarf or face mask), depending on setting
	Empiric trial of combination albuterol-ipratropium 20 to 30 minutes prior to exercise

FEV₁: forced expiratory volume in 1 second; LABA: long-acting beta agonist; LTRA: leukotriene receptor antagonist; SABA: short-acting beta agonist.

* Choice between levalbuterol, LTRA, ipratropium, and cromoglycate is based on drug availability and patient/clinician preference.

¶ LTRA must be taken at least 2 hours prior to exercise if used episodically.

Δ Patient will still need to have a SABA inhaler available for treatment of breakthrough symptoms.

Graphic 105874 Version 3.0

خرید پکیج

Management of exercise-induced bronchoconstriction (EIB)