Exercise-induced bronchoconstriction - Breathless Athlete

What is a Exercise-induced bronchoconstriction - Breathless Athlete

Exercise-induced bronchoconstriction (EIB) is a condition in which physical activity triggers the transient narrowing of the airways in the lungs, resulting in symptoms similar to asthma. It primarily affects individuals with underlying asthma or a history of respiratory problems, but it can also occur in people without a previous asthma diagnosis. It affects 6-12% of the population but the prevalence in athletes can vary from 4-48% depending upon increased training loads and the environment.
During exercise, the breathing rate and depth increase, causing the airways to cool and dry out. In individuals with EIB, this can lead to inflammation and constriction of the airways, making it difficult to breathe.

Exercise-induced bronchoconstriction - Breathless Athlete

The symptoms of EIB typically occur during or immediately after exercise and may include:

1. Shortness of breath
2. Wheezing
3. Coughing
4. Chest tightness or pain
5. Fatigue or reduced exercise tolerance

What Causes EIB

The exact cause of EIB is not fully understood, but several factors may contribute to its development. These include the release of inflammatory substances, such as histamines and leukotrienes, during exercise, as well as the cooling and drying effect of increased ventilation. People with EIB often have airway hyperresponsiveness, meaning their airways are more sensitive to various triggers.

Other conditions having similar presentation as EIB

1. Other respiratory problems: Asthma, Aspiration, Pneumonia, Cystic fibrosis.
2. Vocal cord dysfunction, Exercise induced Laryngochalasia
3. Cardiac issues: Valvular issues, Left ventricular dysfunction, Ischemic heart disease.
4. Gastrointestinal reflux disease,
5. Psychological issues- anxiety

EIB Athletes

How is EIB diagnosed?

EIB can be diagnosed with Bronchopulmonary challenge tests. The tests can be:
Direct challenge tests: Histamine test, methacholine test, Hypertonic saline test
Indirect challenge tests: Eucapnic voluntary hyperventilation tests (gold standard), Exercise provocation test, Cold air challenge

What are the treatment options for EIB?

The treatment options for EIB and underlying asthma may include:
1. Short-acting bronchodilators: These medications provide quick relief by relaxing the airway muscles and can be used before exercise to prevent symptoms.
2. Long-acting bronchodilators: These medications provide long-term control of symptoms.
3. Inhaled corticosteroids: These anti-inflammatory medications can help reduce airway inflammation and are often used in combination with bronchodilators for long-term management.
4. Leukotriene modifiers: These medications block the effects of leukotrienes, which are inflammatory substances involved in EIB.
5. Avoidance of triggers: Taking preventive measures such as warming up before exercise, exercising in a warm and humid environment, and wearing a mask or scarf over the mouth and nose during exercise in cold weather and dietary changes to low salt diet, use of vit C and omega 2 fatty acids can help reduce EIB symptoms.

ASTHMA Athletes

Doping challenge:
Always check (Prohibited Substances and methods | Sports Integrity Australia and Global DRO - Home) and ensure the medication being used is not prohibited, as some are prohibited for its use during the competition, and some are allowed only conditionally. If an athlete needs any of the prohibited medications, then they can apply for Therapeutic Use Exemption ((TUE)

It's important to note that EIB can be managed effectively with appropriate treatment and lifestyle adjustments, allowing individuals to continue participating in physical activities. Working closely with a healthcare professional can help in developing a personalized management plan based on your specific needs.
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