American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/528960
Treatment Î For patients with EIB, the ATS recommends administration of an inhaled short-acting β 2 -agonist (SABA) before exercise (strong recommendation, high-quality evidence). • The SABA is typically administered 15 minutes before exercise. Î A controller agent is generally added whenever SABA therapy is used daily or more frequently. For patients with EIB who continue to have symptoms despite using an inhaled SABA before exercise, or who require an inhaled SABA daily or more frequently: Î The ATS recommends against daily use of an inhaled long-acting β 2 -agonist as single therapy (strong recommendation, moderate-quality evidence). This is based upon a strong concern for serious side effects. Î The ATS recommends daily administration of an inhaled corticosteroid (ICS) (strong recommendation, moderate-quality evidence). • It may take 2-4 weeks after the initiation of therapy to see maximal improvement. Î The ATS recommends against administration of ICS only before exercise (strong recommendation, moderate-quality evidence). Î The ATS recommends daily administration of a leukotriene receptor antagonist (strong recommendation, moderate-quality evidence). Î The ATS recommends administration of a mast cell stabilizing agent before exercise (strong recommendation, high-quality evidence). Î The ATS suggests administration of an inhaled anticholinergic agent before exercise (weak recommendation, low-quality evidence). Î In our clinical practices, we generally add a daily inhaled ICS or a daily leukotriene receptor antagonist first, with the choice between these agents made on a case-by-case basis depending upon patient preferences and baseline lung function. Mast cell stabilizing agents and inhaled anticholinergic agents play a secondary role. Î For patients with EIB and allergies who continue to have symptoms despite using an inhaled SABA before exercise, or who require an inhaled SABA daily or more frequently, the ATS suggests administration of an antihistamine (weak recommendation, moderate-quality evidence). In contrast, the ATS recommends against administration of antihistamines in patients with EIB who do not have allergies (strong recommendation, moderate-quality evidence). Î For all patients with EIB, the ATS recommends interval or combination warm-up exercise before planned exercise (strong recommendation, moderate-quality evidence). Î For patients with EIB who exercise in cold weather, the ATS suggests routine use of a device (i.e., mask) that warms and humidifies the air during exercise (weak recommendation, low-quality evidence).