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Exercise-Induced Asthma

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➤ The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent. ➤ Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment. • The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes. ➤ The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB). ➤ EIB is frequently documented with asthma and reflects insufficient control of underlying asthma. ➤ Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment. ➤ Summary Statement (SS)1: In asthmatic patients EIB can indicate lack of control of the underlying asthma. Therefore treat the uncontrolled asthma to get control of EIB. (S-D) ➤ SS2: A diagnosis of EIB should be confirmed by demonstration of airways reversibility or challenge in association with a history consistent with EIB because self-reported symptoms are not adequate. (S-B) ➤ SS3: Evaluate EIB in elite athletes by using objective testing. (S-B) ➤ SS4: Perform a standardized bronchoprovocation (exercise or a surrogate) challenge to diagnose EIB because the prevalence of EIB will vary with the type of challenge and the conditions under which the challenge is performed. (S-A) ➤ SS5: In subjects with no current clinical history of asthma, use an indirect ungraded challenge (eg, exercise challenge or surrogate testing, such as with EVH) for assessing EIB in the recreational or elite athlete who has normal lung function. (S-D) Key Points Diagnosis

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