EXERCISE-INDUCED BRONCHOCONSTRICTION IN ATHLETES - PATHOMECHANISM, CLINICAL SYMPTOMS, AND CURRENT METHODS OF TREATMENT AND PREVENTION

Anna  Maruszak; Urszula  Majda; Magdalena Michalik; Magdalena Mida; Julia Kwiecień; Julia Stołtny; Justyna Goryczka; Magdalena Lisik; Witold Kimla; Natalia Hajok

doi:10.31435/ijitss.1(49).2026.4903

Authors

Anna Maruszak American Heart of Poland S.A., Ustroń, Poland https://orcid.org/0009-0009-2871-8800
Urszula Majda Jędrzej Śniadecki Specialist Hospital in Nowy Sącz, Nowy Sącz, Poland https://orcid.org/0009-0001-5144-2883
Magdalena Michalik Hospital of the Brothers Hospitallers of Saint John of God, Cracow, Poland https://orcid.org/0009-0003-6463-0802
Magdalena Mida Sosnowiec Municipal Hospital, Sosnowiec, Poland https://orcid.org/0009-0006-2815-6893
Julia Kwiecień Municipal Hospital in Ruda Slaska, Ruda Śląska, Poland https://orcid.org/0009-0009-2458-3224
Julia Stołtny Zagłębie Clinical Hospital in Czeladź, Czeladź, Poland https://orcid.org/0009-0008-0162-1809
Justyna Goryczka District Hospital in Chrzanów, Chrzanów, Poland https://orcid.org/0009-0004-4660-8318
Magdalena Lisik Szpital Grochowski im. dr med. Rafała Masztaka SPZOZ, Warszawa, Poland https://orcid.org/0009-0000-6196-3386
Witold Kimla District Hospital in Chrzanów, Chrzanów, Poland https://orcid.org/0009-0001-0695-9541
Natalia Hajok Individual Medical Practice, Poland https://orcid.org/0009-0003-5305-6075

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4903

Keywords:

Exercise-Induced Asthma, EIB, Diagnosis, FEV1, Athletes, Prevention

Abstract

Introduction and objective: This article discusses the issue of exercise-induced bronchoconstriction (EIB), also known as exercise-induced asthma (EIA). The aim of this paper is to discuss current methods of diagnosis and treatment of EIB in athletes in light of current guidelines.

Methodology: The ATS (American Thoracic Society) guidelines and available laboratory tests assessing bronchial hyperresponsiveness to indirect stimuli, such as exercise tests on a treadmill or cycle ergometer, eucapnic hyperventilation (EVH) and provocation tests using mannitol or hypertonic saline, and measurement of nitric oxide concentration in exhaled air (FENO).

Results: It was established that the diagnosis of EIB requires a decrease in forced expiratory volume in 1 second (FEV) of at least 10% after physical exercise. The prevalence of the condition is estimated at 12–15% in the general population, between 10–20% in athletes competing in summer Olympic sports, and increasing to 50–70% in athletes competing in winter sports. The key mechanisms of post-exercise bronchoconstriction are the thermal and osmotic theories.

Conclusions: Effective prevention of EIB includes both non-pharmacological methods and pharmacotherapy (primarily short- and long-acting beta2-mimetics, anti-leukotriene drugs). In patients with asthma, proper control of airway inflammation significantly reduces the severity of exercise-induced symptoms.

References

Hildebrand, K. (2011). Powysiłkowy skurcz oskrzeli. Pneumonologia i Alergologia Polska, 79, 39–47.

Gotshall, R. W. (2002). Exercise-induced bronchoconstriction. Drugs, 62(12), 1725–1739. https://doi.org/10.2165/00003495-200262120-00003

American Thoracic Society. (2000). Guidelines for methacholine and exercise challenge testing—1999. American Journal of Respiratory and Critical Care Medicine, 161(1), 309–329. https://doi.org/10.1164/ajrccm.161.1.ats11-99

Brudno, D. S., Wagner, J. M., & Rupp, N. T. (1994). Length of postexercise assessment in the determination of exercise-induced bronchospasm. Annals of Allergy, 73(3), 227–231.

Chhabra, S. K., & Ojha, U. C. (1998). Late asthmatic response in exercise-induced asthma. Annals of Allergy, Asthma & Immunology, 80(4), 323–327.

Carlsen, K. H., Anderson, S. D., Bjermer, L., et al. (2008a). Exercise-induced asthma, respiratory and allergic disorders in elite athletes: Epidemiology, mechanisms and diagnosis. Allergy, 63(4), 387–403. https://doi.org/10.1111/j.1398-9995.2008.01662.x

Weiler, J. M., Bonini, S., Coifman, R., et al. (2007). Exercise-induced asthma. Journal of Allergy and Clinical Immunology, 119(6), 1349–1358. https://doi.org/10.1016/j.jaci.2007.02.041

Abbasi, A., Vieira, R. D. P., & Northoff, H. (2015). Letter to the editor: The evidence of exercise-induced bronchoconstriction in endurance runners; genetic basis and gender differences. Exercise Immunology Review, 21, 186–188.

Ora, J., De Marco, P., Gabriele, M., Cazzola, M., & Rogliani, P. (2024). Exercise-induced asthma: Managing respiratory issues in athletes. Journal of Functional Morphology and Kinesiology, 9(1), 15. https://doi.org/10.3390/jfmk9010015

Hostrup, M., Hansen, E. S. H., Rasmussen, S. M., Jessen, S., & Backer, V. (2024). Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scandinavian Journal of Medicine & Science in Sports, 34(1), e14358. https://doi.org/10.1111/sms.14358

Anderson, S. D., & Kippelen, P. (2008). Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes. Journal of Allergy and Clinical Immunology, 122(2), 225–235. https://doi.org/10.1016/j.jaci.2008.05.001

Carlsen, K. H., Delgado, L., & Del Giacco, S. (2005). Diagnosis, prevention and treatment of exercise-related asthma, respiratory and allergic disorders in sports. European Respiratory Monograph, 10, 102–104.

Hallstrand, T. S., Moody, M. W., Aitken, M. L., & Henderson, W. R. (2005). Airway immunopathology of asthma with exercise-induced bronchoconstriction. Journal of Allergy and Clinical Immunology, 116(3), 586–593. https://doi.org/10.1016/j.jaci.2005.04.035

Karjalainen, E. M., Laitinen, A., Sue-Chu, M., et al. (2000). Evidence of airway inflammation and remodeling in ski athletes. American Journal of Respiratory and Critical Care Medicine, 161(6), 2086–2091. https://doi.org/10.1164/ajrccm.161.6.9907025

Helenius, I., & Haahtela, T. (2000). Allergy and asthma in elite summer sport athletes. Journal of Allergy and Clinical Immunology, 106(3), 444–452. https://doi.org/10.1067/mai.2000.107749

Sue-Chu, M., Karjalainen, E. M., Altraja, A., et al. (1998). Lymphoid aggregates in endobronchial biopsies from young elite cross-country skiers. American Journal of Respiratory and Critical Care Medicine, 158(2), 597–601. https://doi.org/10.1164/ajrccm.158.2.9711012

Sue-Chu, M., Larsson, L., Moen, T., Rennard, S. I., & Bjermer, L. (1999). Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers. European Respiratory Journal, 13(3), 626–632.

Hallstrand, T. S., Moody, M. W., Wurfel, M. M., et al. (2005). Inflammatory basis of exercise-induced bronchoconstriction. American Journal of Respiratory and Critical Care Medicine, 172(6), 679–686. https://doi.org/10.1164/rccm.200412-1667OC

Schwartz, L. B., Delgado, L., Craig, T., et al. (2008). Exercise-induced hypersensitivity syndromes in athletes. Allergy, 63(8), 953–961. https://doi.org/10.1111/j.1398-9995.2008.01802.x

Weiss, P., & Rundell, K. W. (2009). Imitators of exercise-induced bronchoconstriction. Allergy, Asthma & Clinical Immunology, 5, 7. https://doi.org/10.1186/1710-1492-5-7

Fitch, K. D., Sue-Chu, M., Anderson, S. D., et al. (2008). Asthma and the elite athlete: Summary of the International Olympic Committee’s consensus conference. Journal of Allergy and Clinical Immunology, 122(2), 254–260. https://doi.org/10.1016/j.jaci.2008.06.021

Hallstrand, T. S., Curtis, J. R., Koepsell, T. D., et al. (2002). Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. Journal of Pediatrics, 141(3), 343–349.

Roca, J., Whipp, B. J., Agusti, A. G. N., et al. (1997). Clinical exercise testing with reference to lung diseases. European Respiratory Journal, 10(11), 2662–2689.

Stanojevic, S., Kaminsky, D. A., Miller, M. R., et al. (2021). ERS/ATS technical standard on lung function tests. European Respiratory Journal, 60, 2101499. https://doi.org/10.1183/13993003.01499-2021

Crapo, R. O., Casaburi, R., Coates, A. L., et al. (2000). Guidelines for methacholine and exercise challenge testing—1999. American Journal of Respiratory and Critical Care Medicine, 161(1), 309–329. https://doi.org/10.1164/ajrccm.161.1.ats11-99

Rundell, K. W., Wilber, R. L., Szmedra, L., et al. (2000). Exercise-induced asthma screening of elite athletes. Medicine & Science in Sports & Exercise, 32(2), 309–316.

American Thoracic Society & American College of Chest Physicians. (2003). ATS/ACCP statement on cardiopulmonary exercise testing. American Journal of Respiratory and Critical Care Medicine, 167(2), 211–277.

Joos, G. F., O’Connor, B., Anderson, S. D., et al. (2003). Indirect airway challenges. European Respiratory Journal, 21(6), 1050–1068.

International Olympic Committee. (2008). Beta2-adrenoceptor agonists and the Olympic Games in Beijing. https://olympics.com

Anderson, S. D., Argyros, G. J., Magnussen, H., & Holzer, K. (2001). Provocation by eucapnic voluntary hyperpnoea to identify exercise-induced bronchoconstriction. British Journal of Sports Medicine, 35(5), 344–347. https://doi.org/10.1136/bjsm.35.5.344

Brannan, J. D., Koskela, H., Anderson, S. D., & Chew, N. (1998). Responsiveness to mannitol in asthmatic subjects with exercise- and hyperventilation-induced asthma. American Journal of Respiratory and Critical Care Medicine, 158(4), 1120–1126. https://doi.org/10.1164/ajrccm.158.4.9804065

Anderson, S. D., Brannan, J. D., Spring, J., Spalding, N., Rodwell, L. T., Chan, K., Gonda, I., Walsh, A., & Clark, A. R. (1997). A new method for bronchial provocation testing in asthmatic subjects using a dry powder of mannitol. American Journal of Respiratory and Critical Care Medicine, 156(3), 758–765. https://doi.org/10.1164/ajrccm.156.3.9610044

Anderson, S. D., Charlton, B., Weiler, J. M., et al. (2009). Mannitol vs methacholine challenge. Respiratory Research, 10, 4. https://doi.org/10.1186/1465-9921-10-4

Anderson, S. D. (1996). Exercise-induced asthma and use of hypertonic saline aerosol as a bronchial challenge. Respirology, 1(3), 175–180. https://doi.org/10.1111/j.1440-1843.1996.tb00033.x

Dickinson, J., Gowers, W., Sturridge, S., et al. (2023). Fractional exhaled nitric oxide in the assessment of exercise-induced bronchoconstriction: A multicenter retrospective analysis. Scandinavian Journal of Medicine & Science in Sports, 33, 1221–1230. https://doi.org/10.1111/sms.14367

Grzelewski, T., & Stelmach, I. (2009). Exercise-induced bronchoconstriction in asthmatic children: A comparative systematic review. Drugs, 69(12), 1533–1553.

Carlsen, K. H., Anderson, S. D., Bjermer, L., et al. (2008). Treatment of exercise-induced asthma and doping. Allergy, 63(5), 492–505.

Stickland, M. K., Rowe, B. H., Spooner, C. H., Vandermeer, B., & Dryden, D. M. (2012). Effect of warm-up exercise on exercise-induced bronchoconstriction. Medicine & Science in Sports & Exercise, 44(3), 383–391. https://doi.org/10.1249/MSS.0b013e31822fb73a

Gotshall, R. W., Mickelborough, T. D., & Cordain, L. (2000). Dietary salt restriction improves pulmonary function in exercise-induced asthma. Medicine & Science in Sports & Exercise, 32(11), 1815–1819.

Mickelborough, T. D., Murray, R. L., Ionescu, A. A., & Lindley, M. R. (2003). Fish oil and EIB. American Journal of Respiratory and Critical Care Medicine, 168(10), 1181–1189.

Greiwe, J., Cooke, A., Nanda, A., et al. (2020). Diagnosis and management of EIB in athletes. Journal of Allergy and Clinical Immunology: In Practice, 8(8), 2542–2555. https://doi.org/10.1016/j.jaip.2020.05.020

Global Initiative for Asthma. (2023). Global strategy for asthma management and prevention. https://ginasthma.org