March 2, 2020
When a patient comes into the clinic complaining of being short of breath during exercise, one of the diagnoses that should be screened for is exercise-induced
bronchoconstriction, said Dr. Russ Guin, a sports medicine fellow at the College of Community Health Sciences. Guin also cares for patients at University Medical Center, which the College operates.
EIB is often used interchangeably with exercise-induced asthma, but they are different conditions. EIB is a distinct form of airway hyperresponsiveness in response to exercise. EIB patients present no signs of asthma outside of their exercise regime.
During his Grand Rounds series presentation, Guin said approximately 12% of the population experiences EIB and it is most common in cold-weather and indoor sports. Athletes who ski, swim or play ice hockey are more likely to experience EIB. Endurance athletes are also at higher risk for EIB.
“Asthma and EIB should not be a limiting factor for your athletes,” Guin said. “It should be under control.”
People with a family history of asthma or allergic rhinitis are at a higher risk of EIB. Guin said that the exact reason athletes have EIB symptoms is unknown, but it may have to do with the cooling and dehydration of airways during exercise.
EIB symptoms start within five to 10 minutes of exercise and may persist for up to a few hours after exercise ends. Athletes with EIB may present with signs of respiratory distress acutely or pulmonary changes may be more subtle such as wheezing or coughing. Guin said looking at the skin for signs of eczema is another important clue.
“You have to nail this diagnosis,” Guin said. “You can try giving athletes a treatment for the symptoms, but that’s not the best way.”
EIB diagnosis can be done with spirometry, field testing with a peak flow meter or bronchoprovocation testing. Spirometry measures how much air is inhaled and exhaled and how quickly it is exhaled. A bronchoprovocation tests lung function after exposure to common triggers.
The most widely available and affordable method is bronchoprovocation using a treadmill with pulmonary function testing, Guin said.
Managing EIB to control symptoms over a long period of time is the ideal goal. Patients have to be educated about their diagnosis and triggers, Guin said. Behavioral and pharmacologic treatments are available to manage EIB.
The College’s Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process.