Exercise
EVH
b
Mannitol
c
FEV1 ≥70%
Reversible airway obstruction
consistent with asthma and
high risk of EIB
β
2
agonist
reversibility
a
Treatment for EIB
• β
2
agonists are most effective at short-term protection against EIB
and for accelerating recovery of EIB. (SS18,19)
• Daily use of either SABA or LABA, even in combination with ICS,
usually will lead to tolerance defined as reduction in duration of β
2
agonist protection and prolongation of β
2
agonist recovery from
EIB. (SS20)
• Leukotriene inhibitors can be used intermittently or as maintenance
prophylaxis. However, protection may be incomplete (SS21)
• Mast cell stabilizers
c
attenuate EIB and have a short duration of
action. (SS22)
• Regular ICS can decrease the frequency and severity of EIB but
they do not eliminate the need for additional acute therapy with a
β
2
agonist or other agents. (SS23)
• Non-pharmacologic therapy such as warm-up can reduce the
severity of EIB. (SS26)
Indirect Bronchial Provocation Testing
No β
2
agonist
reversibility
YES AHR
NO AHR
a
Demonstrating reversibility in FEV
1
of 12% and 200 mL
b
FEV
1
≥75% for EVH challenge
c
Subject to availability in the USA
d
Including D
LCO
& plethysmography
Italics: indicate recommended procedures
