1. Fawzia abo ali
Prof.of allergy &clinical immunology
Faculty of medicine
Ain shams university
2.
3. Exercise-induced
asthma & bronchospasm
• Definition: Airway obstruction, and hyper
responsiveness, triggered by exercise
- EIA: exercise induces symptoms of asthma in
patients who have asthma (90% of patients)
- EIB: exercise induces bronchospasm in patients
without chronic asthma, for example, an elite athlete.
4. physical activity is the second leading cause of airway
constriction after upper respiratory tract infections.
EIA: symptoms start after exercise, peak 8 to 15 minutes
after exercise and spontaneously resolve in 60 minutes.
EIA is diagnosed by a 15% decrease in FEV1.
EIA is most frequently seen in children and young adults
because of their high levels of physical activity.
5. Epidemiology
EIA affects:
90% of asthmatics
40-50% of patients with allergic rhinitis
3-13% of the general population
10-20% of athletes
6. Asthmogenic exercise:
The type of exercise performed directly affects
the intensity and duration of an EIA episode.
Asthmogenic sports are characterized by
sustained hyperpnea (deep, rapid breathing
during intense, prolonged aerobic activity)
- basketball
- cycling
- running
- hockey
7. Less asthmogenic sports:
sport that produces intermittent bursts of
hyperpnea, such as baseball, weight lifting
or tennis.
In addition, activities such as bike-riding
and swimming are less likely to induce EIA
than running.
Swimming appears to be the least
asthmogenic sport, which may in part be
related to the inhalation of humidified air.
8. The sequence of events in EIA is characteristic:
1. Airways dilate during exercise (FEV1 increases by
5% in normal people).
2. When the exercise is over, airway obstruction
begins and progresses until it reaches a peak in 5-10
minutes
3. Spontaneous resolution occurs in 30 minutes.
The tendency toward spontaneous remission is a
hallmark of EIA: one needs only to reverse the acute
event and the patient will then remain free of
symptoms.
9.
10. Pathogenesis
There are 2 theories for EIA pathogenesis:
thermal osmotic
Thermal hypothesis, there is no role for
biochemical mediators.
Osmotic theory has been gaining a wider
acceptance in recent years.
12. Several studies have noted an increase in the
concentration of cysteinyl leukotrienes (CysLTs) in the
airways of patients with EIB.
a recent study found that the fraction of exhaled nitric
oxide (FENO) is elevated in asthmatic patients with EIB,
Angiopoetin 2, a mediator that enhances microvascular
permeability, is increased in the airways in EIB
Mast cell infiltration of the airways has also been
implicated in EIB.
13. Duration of EIA Symptoms
• Symptoms begin during
or after exercise and
usually worsen 5-20
minutes after stopping
activity
• Some people experience
a “late-phase reaction” 4-
12 hours after exercising.
Symptoms usually less
severe.
14. Diagnosis
Exercise-induced asthma can be diagnosed by history
only and formal testing is usually required only in
competitive athletes.
Points in the patient history:
- Onset during or after exercise
- EIB not affect first 5 minutes of exercise
- Symptoms duration longer than 5 minutes
15.
16. Testing for EIA
- FRAST: free running asthma screening test
- Treadmill exercise test
- Cycling
FRAST
A simple screening test in children:
1. Establish a baseline PEF.
2. Have the child run continuously for 7 minutes (same
duration as treadmill exercise test), OR have the child run
until he/she has symptoms.
3. Check PEF, more than 15% decrease in PEF is
diagnostic of EIA.
18. Bronchial provocation tests used to diagnose asthma
in athletes
• Methacholine challenge
• Exercise challenge
• Mannitol inhalation
• Eucapnic voluntary hyperpnea
• Hypertonic saline challenge
19. Management
Non-pharmacological treatment:
- Ensure patient has taken asthma
medicine
• Warm-up and Cool down periods
• Hydrate before, during and after
exercise
• Check pollen and air quality
• Cold Weather
• - breath through the nose
20. Pharmacological treatment
Mnemonic for drugs used for treatment of EIB -
CLIMB:
Cromolyn
Leukotriene receptor antagonist (LTRA),
montelukast
Inhaled steroids (ICS)
Mast cell stabilizers other than cromolyn
Beta-2 agonists, albuterol
21.
22.
23. In conclusion
• EIA is common affecting10-20% of the general
population, and up to 90% of unselected asthmatics
• It is easily managed with warm-up and cool-
down, nasal breathing and pre-medication.
• Cough post exercise best predictor for positive
exercise challenge test
• 90% can be successfully treated with pre exercise
MDI
• Return to play usually safe
• Control of Exercise-induced asthma affords a healthy
lifestyle in which exercise is performed without
restrictions.
24. Resources
• American College of Allergy, Asthma, and Immunology
– http://www.acaai.org
• American College of Chest Physicians
– http://www.chestnet.org
• American Thoracic Society
– http://www.thoracic.org
• The Centers for Disease Control and Prevention
– http://www.cdc.gov/asthma
• National Asthma Education and Prevention Program
– http://www.nhlbi.nih.gov/about/naepp/
• Asthma and Allergy Foundation of America
– http://www.aafa.org
• American Lung Association
– http://www.lungusa.org
• American Academy of Allergy, Asthma, and Immunology
– http://www.aaaai.org
• Allergy and Asthma Network/Mothers of Asthmatics, Inc.
– http://www.aanma.org
Hinweis der Redaktion
Symptoms may begin during exercise and will usually worsen 5-20 minutes after your student stops the activity. Some individuals may experience a “late-phase reaction” 4-12 hours after exercising. These symptoms are usually less severe, but may last up to 24 hours. Students who are experiencing minor symptoms or are recovering from a recent asthma attack or episode/ illness may require exercise/activity modification. You may need to be creative to include these students, but participating at any level is better than being left out.
