What is it?
“Exercise-induced bronchoconstriction” (EIB) occurs when a person’s airway becomes temporarily narrowed, either during, or soon after, exercise. Depending on the population being examined, anywhere from 10-70% of people may be affected by this. Those with asthma are most likely to experience exercise-induced bronchoconstriction. Other factors that increase the risk of this include having seasonal allergies, having a family member with asthma or allergies, smoking, and environmental exposures such as to chlorine in a swimming pool.

Symptoms
Those affected by exercise-induced bronchoconstriction experience excessive shortness of breath with exercise. It is often accompanied by wheezing, coughing, and chest tightness. Some athletes might mistake these symptoms for simply being out of shape. The intensity of EIB varies – some athletes experience shortness of breath with any exercise, while others have symptoms only during or after vigorous exercise.

Sports Medicine Evaluation
A sports medicine physician will use a stethoscope to listen for wheezing in the lungs, although this is only occasionally present during or immediately after exercise. Direct measurement of airflow before and after exercise can be done to confirm the diagnosis. Measurement of airflow before and after giving a patient medicine to open up the airways also helps screen for baseline asthma. Occasionally, a physician may suggest using an inhaler prior to exercise before any testing is done. If this makes the symptoms go away, no additional testing may be required. If a person is experiencing a decline in his or her athletic performance, a sports medicine physician may also assess for other causes in addition to exercise-induced bronchoconstriction.

Treatment and Injury Prevention
If a person has asthma, the first step is to get it under control. Those with known triggers (such as allergens and cold air) should avoid them if possible. Treatment may simply be limited to this. For most people with exercise-induced bronchoconstriction, an inhaler that opens up the airways can be used 15-30 minutes before exercising with good effect.

Return to Play
When symptoms are adequately controlled, there are no restrictions on exercise or athletic competition. Having an inhaler available during practices and competitions is important for athletes with exercise-induced bronchoconstriction.

AMSSM Member Authors
Brett Toresdahl , MD and Chad Carlson, MD

References
Krafczyk MA, Asplund CA. Exercise-induced bronchoconstriction: diagnosis and management. Am Fam Physician. 2011 Aug 15;84(4):427-34.

Weiler JM, Anderson SD, Randolph C. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol. 2010 Dec;105(6 Suppl):S1-47.