Therapy
Introduction
ÎÎFrequent EIB in asthmatic patients suggests inadequate asthma control
and requires patient reevaluation to determine the need for additional
therapy. (D)
ÎÎFailure of appropriate pharmacotherapeutic agents to prevent EIB indicates
the need to reevaluate the diagnosis. (D)
ÎÎSeveral pharmacotherapeutic agents are effective when given for the
prevention or attenuation of EIB. They differ in their mechanisms of action
and overall effectiveness. In addition, there is both intrapatient and
interpatient variability in responsiveness. (A)
ÎÎMedications may differ in effectiveness over time because of variability of
asthma, environmental conditions, intensity of the exercise stimulus, and
tachyphylaxis. (A)
β2-Adrenergic Receptor Agonists
ÎÎInhaled β2-adrenergic receptor agonists are the most effective group of
agents for short-term protection against EIB and for accelerating recovery
of FEV1 to baseline when given after a decrease in FEV1 after exercise. (A)
ÎÎWhen given as a single dose or on an intermittent basis, SABAs and LABAs
may protect against or attenuate EIB. SABAs are usually effective for 2 to 4
hours and LABAs for up to 12 hours. (A)
ÎÎDaily use of β2-adrenergic agents alone or in combination with ICS
usually will lead to tolerance manifested as a reduction in duration and/
or magnitude of protection against EIB and a prolongation of recovery in
response to SABA after exercise. Therefore, monotherapy with adrenergic
agents is generally recommended for use only on an intermittent basis for
prevention of EIB. (A)
ÎÎRegular (eg, daily) use of
efficacy of the agent. (A)
β2-agonists for EIB leads to relative loss of
Leukotriene Inhibitors
ÎÎDaily therapy with leukotriene inhibitors does not lead to tolerance and can
be used for intermittent or maintenance prophylaxis. However, it provides
protection that may not be complete and has no use to reverse airway
obstruction when it occurs. (A)
Mast Cell Stabilizers
ÎÎCromolyn sodium and nedocromil sodium (currently not available in the
United States in an inhaled form) when inhaled shortly before exercise
attenuate EIB but have a short duration of action. They do not have a
bronchodilator activity. They may be effective alone or as added therapy
with other drugs for EIB. (A)
