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Exercise-induced bronchoconstriction

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of exercise-induced bronchoconstriction are prepared by our editorial team based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI/ACAAI 2016) and the American Thoracic Society (ATS 2013).
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Screening and diagnosis

Diagnosis: as per AAAAI/ACAAI 2016 guidelines, confirm the diagnosis of EIB by demonstrating airways reversibility or challenge in association with a history consistent with EIB because self-reported symptoms are not adequate.
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  • Differential diagnosis

Diagnostic investigations

Bronchoprovocation testing: as per AAAAI/ACAAI 2016 guidelines, obtain a standardized bronchoprovocation (exercise or a surrogate) challenge for the diagnosis of EIB, as the prevalence of EIB varies with the type of challenge and the conditions under which the challenge is performed.
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Medical management

General principles: as per AAAAI/ACAAI 2016 guidelines, recognize that EIB in patients with asthma can indicate lack of control of underlying asthma. Treat uncontrolled asthma to get control of EIB.
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  • Inhaled beta-2 agonists

  • ICSs

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  • Inhaled anticholinergics

  • Leukotriene receptor antagonists

  • Antihistamines

Nonpharmacologic interventions

Warm-up exercises: as per AAAAI/ACAAI 2016 guidelines, advise practicing pre-exercise warm-up in patients with EIB to reduce the severity of EIB.
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