Figure 1. Symptom(s) of EIB in Patient Who Does or Does Not
Have Asthma
History, physical examination
Pulmonary function testing (pre- and post-bronchodilator)
Workup suggests
syndrome other than EIB
Consider other diagnoses:
>> Physiologic limitation
>> Vocal cord
abnormalities
>> Anxiety
hyperventilation
syndrome
>> Obesity related dyspnea
>> Cardiac abnormalities
>> IAHE
>> Pulmonary
arteriovenous
malformations
>> Other diagnoses
Recommend further
workup when indicated,
such as:
>> ECG
>> Echocardiography
>> Holter monitor
>> Exercise rhinoscopy
>> Chest X-ray
>> Pulmonary exercise
stress test
Negative
(or not done)
Workup suggests EIB with
or without asthma or is
entirely normal
Baseline FEV1
< 70% predicted
No
therapeutic
response
≥ 70% predicted
Therapeutic
response
(if challenge
not already
done)
Indirect challenge:
>> Exercise with dry air
>> EVH
>> Inhaled powdered
mannitol
>> Sports-specific field
challenge
>> Other
Add controller medication:
>> Inhaled corticosteroids
>> Leukotriene modifier
Avoid triggers and give
albuterol for as-needed use
No therapeutic
response to
albuterol
Positive
Consider
methacholine challenge
Avoid triggers;
give albuterol for
as-needed use
Positive
Negative
Sports-specific field
challenge designed
to reproduce signs
and symptoms (if not
already done)
Positive
(symptoms and
spirometry)
Symptoms only with negative challenge,
or sports-specific field challenge not done
