ICSs
➤ SS23: Consider prescribing ICSs in combination with other therapies
because ICSs can decrease the frequency and severity of EIB but not
necessarily eliminate it. (S-A)
➤ SS24: Do NOT prescribe daily LABAs with ICS therapy to treat EIB unless
needed to treat moderate-to- severe persistent asthma. The ICS might
not prevent the occurrence of tolerance from daily β
2
-agonist use. (S-A)
Anticholinergic Agents
➤ SS25: Consider prescribing inhaled ipratropium bromide for patients
who have not responded to other agents. However, its ability to attenuate
EIB is inconsistent. (W-A)
Nonpharmacologic Therapy
➤ SS26: Prescribe pre-exercise warm-up for EIB because it can be helpful
in reducing the severity of EIB. (S-A)
➤ SS27: Consider with caution the recommendation of reduction of sodium
intake and ingestion of fish oil and ascorbic acid supplementation;
results are questionable in reducing the severity of EIB. (W-B)
Competitive and Elite Athletes
➤ SS28: Treat athletes with EIB alone in a similar manner to those with EIB
and asthma by using the recommended general treatments for asthma.
This might require additional consideration in athletes in whom some
governing bodies might have requirements for obtaining permission to
receive pharmaceutical agents for competition. (S-A)
