Materiały źródłowe

• #1 Exercise-Induced Bronchoconstriction: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0815/p427.html

  Exercise-induced bronchoconstriction describes the narrowing of the airway that occurs with exercise. More than 10 percent of the general population and up to 90 percent of persons previously diagnosed with asthma have exercise-induced bronchoconstriction. […] Spirometry should be performed initially to evaluate for underlying chronic asthma, although results are often normal. An empiric trial of short-acting beta2 agonists or additional bronchial provocation testing may be necessary to confirm the diagnosis. […] Self-reported symptoms alone should not be used to diagnose EIB. […] The exercise challenge test can accurately diagnose EIB. […] In patients with possible EIB, spirometry should be performed to rule out underlying asthma. Normal resting spirometry results are common in patients with EIB. If spirometry reveals an obstruction, additional testing before and after albuterol use is recommended.

• #1 Exercise-Induced Asthma: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4174-exercise-induced-asthma

  Exercise-induced asthma happens when your airways get smaller during exercise, making it hard for you to breathe. […] Your provider will ask about your symptoms, including when you have them and how long they last. […] During an exercise challenge test (also called a bronchoprovocation test), you ride on a stationary bike or run on a treadmill. […] Treatment for exercise-induced asthma focuses on preventing and relieving symptoms. […] Your provider may prescribe medications you breathe in using an inhaler or a nebulizer. […] If you have asthma symptoms that start during or shortly after physical activity, you might have exercise-induced asthma. […] If you or your child has symptoms of EIB, call a healthcare provider. […] If you or your child has severe shortness of breath or trouble breathing, seek immediate medical attention.

• #1 Exercise-Induced Asthma: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1938228-overview

  Exercise-induced asthma is a condition of respiratory difficulty (bronchoconstriction) that is related to histamine release, is triggered by aerobic exercise, and lasts several minutes. Causes include medical conditions, environmental factors, and medications. […] The patient’s physical examination is often unremarkable in the clinical setting but may have a higher yield on the field or after an exercise challenge. […] Exercise-induced asthma is generally a clinical diagnosis. Laboratory evaluation is usually reserved for equivocal cases, for treatment failures, and to narrow the differential diagnosis. […] Challenge testing to formalize the diagnosis of exercise-induced asthma includes the following: Treadmill exercise challenges with preexercise and postexercise pulmonary function levels.

• #1 Exercise-Induced Bronchoconstriction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557554/

  Exercise-induced bronchoconstriction (EIB) describes a transient and reversible contraction of bronchial smooth muscle after physical exertion that may or may not produce symptoms of dyspnea, chest tightness, wheezing, and cough. […] Early detection, diagnosis confirmed by the change in lung function during exercise, and treatment can improve quality of life and, when managed appropriately, allows patients to participate freely in exercise without limiting competition at the elite level. […] Screening for EIB is not supported by quality evidence, and further research and development of a symptom measurement tool is needed. […] Clinical diagnosis by symptoms has low sensitivity and specificity, and some patients are asymptomatic. Standardized testing for diagnosis includes direct and indirect methods and usually involves spirometry measurement of FEV1 changes from baseline expressed as a percent decrease.

• #1 Exercise-induced asthma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/diagnosis-treatment/drc-20372306

  To diagnose exercise-induced bronchoconstriction, your health care provider first takes a medical history and does a physical exam. You may have tests to check your lung function and rule out other conditions. […] Your provider will likely perform a spirometry (spy-ROM-uh-tree) test. This exam shows how well your lungs function when you aren’t exercising. A spirometer measures how much air you inhale, how much you exhale and how quickly you exhale. […] Your provider might have you repeat the test after you take an inhaled medicine to open your lungs. This medicine is known as a bronchodilator. Your provider compares the results of the two measurements to see whether the bronchodilator improved your airflow. This initial lung function test is important for ruling out chronic asthma as the cause of symptoms.

• #1 Exercise-induced asthma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/diagnosis-treatment/drc-20372306

  During an exercise challenge test, you run on a treadmill or use other stationary exercise equipment to increase your breathing rate. […] Spirometry tests before and after the challenge can provide evidence of exercise-induced bronchoconstriction. […] This test involves inhaling an agent, often methacholine, that narrows the airways in some people with exercise-induced bronchoconstriction. Afterward, a spirometry test checks lung function. This test mimics the conditions likely to trigger exercise-induced bronchoconstriction.

• #1 Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment

  https://www.mdpi.com/2077-0383/13/15/4558

  Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. EIB is diagnosed when FEV1 decreases ≥ 10% compared with pre-exercise baseline value and is classified as mild when the decrease is ≥10% but <25%, moderate when ≥25% but <50%, and severe when the fall is ≥50%. The exercise challenge test is a noninvasive test conducted in a real-life setting, usually in a controlled environment such as a pulmonary function testing laboratory or a clinic. The exercise challenge test is usually performed in an air-conditioned room with an ambient temperature between 20 and 25 °C. Maintaining low relative humidity, ideally 50% or less, helps prevent excessive moisture in the air, and keeping the inspired air relatively dry and below 25 °C aims at minimizing potential triggers for bronchoconstriction. The assessment of EIB severity consists of comparing pre-exercise FEV1 basal value with the lowest FEV1 value recorded at the specific intervals (5, 10, 15, and 30 min); this difference is then expressed as a percentage of the pre-exercise value. Indirect bronchoprovocation testing may represent a diagnostic option to establish EIB diagnosis. Indirect bronchial provocation tests use external stimuli like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) to cause the endogenous release of bronchoconstrictor mediators from airway inflammatory cells.

• #1 Exercise-Induced Bronchoconstriction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557554/

  The ATS recommends exercise challenge testing in a controlled dry environment. Exercise testing parameters outlined by the ATS include recommendations on ventilation level, heart rate, time at maximal capacity, and medications to hold before testing, including caffeine. […] A fall in FEV1 of greater than or equal to 10% is diagnostic for EIB, with mild at 10% to less than 25%, moderate at 25% to less than 50%, and severe at 50% or greater. […] CHEST guidelines provide 2B recommendation for pulmonary function tests (PFT), exercise or bronchoprovocation studies as described above, and allergy testing for common airborne allergens to distinguish between the most common causes of exercise-induced cough. […] A few smaller studies suggest fractional excretion of nitric oxide (FENO) may replace FEV1 to diagnose and measure the severity of EIB instead of spirometry with FEV1 percent change.

• #1 Exercise-Induced Asthma Workup: Approach Considerations, Allergy and Infection Evaluation, Thyroid Function Evaluation

  https://emedicine.medscape.com/article/1938228-workup

  This requirement has resulted in new studies that have been used to validate some of these assessment tools, whether they are field challenges, treadmill testing, or new techniques such as eucapnic voluntary hyperventilation (EVH). […] At present, the USOC requires EIA to be diagnosed via EVH in order for preventive and treatment-related medications to be used in competition. […] This type of testing formalizes an aerobic challenge and provides an objective measure of the degree of bronchospasm that results from the exercise. […] Any drop from the baseline that is greater than or equal to 10%, on any postexercise measurement, indicates EIA. […] Severity of disease can be classified as follows: Mild – Decrease of 10-20% from baseline, Moderate – Decrease of 20-40% from baseline, Severe – Decrease of greater than 40% from baseline.

• #1 Exercise-Induced Asthma Testing | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/pulmonology/patient-procedures/exercise-induced-asthma-testing

  Your child will be asked to walk briskly or jog on a treadmill. […] Your child also will repeat the spirometry breathing tests at 1 minute, 5 minutes, 10 minutes and 15 minutes after the exercise part of the test. […] Your child then will be given a bronchodilator inhaler to use, and a spirometry breathing test will be done again to see if the medication improves airflow.

• #1 How to Diagnose Exercise Induced Asthma?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3289196/

  Exercise induced asthma (EIA) is a transient increase in airway resistance after intensive exercise and can be measured as a decline in forced expiratory volume in one second (FEV1). […] Several studies have shown that eucapnic voluntary hyperpnea challenge test (EVH test) is a very sensitive and specific diagnostic method. […] EIA can be diagnosed by several methods. However, there is a large variation in their quality and sensitivity, and their prices are rarely comparable. […] Methacholine challenge test is a direct test and is also used in the clinic to diagnose chronic asthma. […] The test is considered positive if the decline in FEV1 is greater than 20% from baseline value (FEV1 measurements at rest). […] The EVH test is an indirect challenge test, which reproduces EIA by hyperventilation of dry gas containing 5% CO2, 21% O2 and balanced N2.

• #1 How to Diagnose Exercise Induced Asthma?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3289196/

  Numerous studies have shown that EVH test results in the diagnosis of most numbers of athletes compared with other tests, which give many false negative diagnoses. […] Many different diagnostic methods have been used over the years to diagnose EIA, but the IOC-MC now recommends EVH test as the most reliable one. […] Methacholine test has widely been used through the years and is also appropriate for diagnosis of chronic asthma, but is neither sensitive nor specific for EIA. […] The osmotic challenge test is both sensitive and specific, and causes a reduction in FEV1 much faster than any other procedures such as hyperventilation or exercise that can take up to 20 minutes.

• #1 Recognition and Management of Exercise-Induced Bronchospasm | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0215/p769.html

  Exercise-induced bronchospasm is an obstruction of transient airflow that usually occurs five to 15 minutes after physical exertion. […] Diagnosis is based on the results of a detailed history, including assessment of asthma triggers, symptoms suggestive of exercise-induced bronchoconstriction, and a normal forced expiratory volume at one second at rest. […] The diagnosis of EIB is based on a detailed history suggestive of shortness of breath, decreased exercise endurance, chest tightness, cough, or wheezing during or immediately following sustained exercise. […] Most patients with EIB have a normal physical examination, with no evidence of wheezing on auscultation. […] The most objective measure of EIB is a pulmonary function test coupled with an appropriate exercise challenge. […] If symptoms are strongly suggestive of EIB, a trial of therapy using a short-acting bronchodilator may be useful to see if the patient significantly improves in performance and symptoms. […] Failure to respond positively to these initial measures should prompt pulmonary function testing with a bronchodilator, exercise challenge testing and, possibly, referral to a specialist.

• #1 Exercise-induced bronchoconstriction – Wikipedia

  https://en.wikipedia.org/wiki/Exercise-induced_bronchoconstriction

  Exercise-induced bronchoconstriction (EIB) occurs when the airways narrow as a result of exercise. This condition has been referred to as exercise-induced asthma (EIA); however, this term is no longer preferred. While exercise does not cause asthma, it is frequently an asthma trigger. […] Exercise-induced bronchoconstriction can be difficult to diagnose clinically given the lack of specific symptoms and frequent misinterpretation as manifestations of vigorous exercise. There are many mimics that present with similar symptoms, such as vocal cord dysfunction, cardiac arrhythmias, cardiomyopathies, and gastroesophageal reflux disease. It is also important to distinguish those who have asthma with exercise worsening, and who consequently will have abnormal testing at rest, from true exercise-induced bronchoconstriction, where there will be normal baseline results. Because of the wide differential diagnosis of exertional respiratory complaints, the diagnosis of exercise-induced bronchoconstriction based on history and self-reported symptoms alone has been shown to be inaccurate and to result in an incorrect diagnosis more than 50% of the time. An important and often overlooked differential diagnosis is exercise-induced laryngeal obstruction (EILO). The latter can co-exist with EIB and is best differentiated using objective testing and continuous laryngoscopy during exercise (CLE) testing.

• #1 Out of shape, or exercise-induced asthma? | Ohio State Health & Discovery

  https://health.osu.edu/wellness/exercise-and-nutrition/out-of-shape-or-exercise-induced-asthma

  It can be difficult for you to perceive the difference between being out of shape and having asthma. That’s why specialized tests can help doctors can diagnose you and find out if medication can help. […] To check specifically for exercise-induced asthma, tests may include specialized pulmonary function testing, electrocardiography, echocardiography, allergy testing or vocal cord tests, depending on your individual symptoms and history. […] The Ohio State Asthma Center also offers a rapid breathing test called Eucapnic Voluntary Hyperventilation (EVH). This is the International Olympic Committee’s preferred method for diagnosing exercise-induced asthma. […] The gold standard of exercised-induced asthma treatment is a prescription albuterol inhaler. You can carry it with you and use it about 15 to 20 minutes before exercise to prevent asthma symptoms. It’s an effective treatment for about 80 percent of exercise-induced asthma cases.

• #1 Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-018-0098-2

  Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. […] Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common. […] To improve the rates of diagnosis of EIB in primary care, validated and widely accepted symptom-based questionnaires are needed that can accurately replicate the current diagnostic standards (forced expiratory volume in 1s reductions observed following exercise or bronchoprovocation challenge) in patients with and without asthma. […] The diagnosis of EIB in patients with and without asthma is multifactorial, leading to the condition often being either under- or over-diagnosed.

• #1 Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-018-0098-2

  A key consideration for physicians when a patient presents with symptoms of wheeze and shortness of breath triggered by exercise is whether a diagnosis of asthma with EIB or EIB alone is appropriate. […] The management of EIB in patients without asthma is very different from the management of patients who experience EIB in association with poorly controlled asthma. […] There is growing evidence that objectively confirmed EIB is more prevalent than would be assumed from using self-reported symptoms alone, possibly because a decline in lung function post exercise (the criterion for EIB) may occur in the absence of symptoms. […] Overall, current estimates reveal that approximately 70% of patients with asthma and EIB are diagnosed based on history and symptoms alone, and only 18% following exercise, medication or lung function testing.

• #1 Exercise-Induced Asthma Treatment in Charlotte | CAAC

  https://www.carolinaasthma.com/exercise-induced-asthma/

  Proper diagnosis and management of exercise-induced asthma are crucial. Misdiagnosis can lead those who suffer from EIA to avoid physical activity, potentially compromising overall health and quality of life. […] Diagnosing exercise-induced asthma will begin with a comprehensive medical history and consultation with an allergist or other healthcare provider. Be prepared to discuss your exercise habits, the specific circumstances when symptoms occur, their frequency, and any patterns you’ve noticed. […] To confirm the diagnosis, your allergist might conduct various breathing tests. The most common test is called a spirometry, which measures how much air you can inhale and exhale and how quickly you can do so. This can be done before exercise as a baseline and then after exercise on a treadmill.

• #1 Exercise-induced Asthma | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/sports-medicine/conditions-treated/exercise-induced-asthma/

  Exercise-induced asthma is often diagnosed in children because of their high level of activity, but it can happen at any age. […] The diagnosis is made with a full history and a physical exam. Lung-function testing may be done to help make the diagnosis. This type of testing involves measuring the athletes ability to blow air out of the lungs before and after taking a medication to help relax the breathing tubes. The person performing the test may ask that some exercise be performed to bring on the symptoms.

• #1 Asthma Diagnosis | AAFA.org

  https://aafa.org/asthma/asthma-diagnosis/

  Your doctor may prescribe a trial with asthma medicine to see if it helps. […] Most people with asthma have allergies that trigger or worsen their asthma. […] Your doctor may order blood tests to check your immune system. […] If your levels are high, this may be a sign of severe asthma. […] If your doctor thinks you have something other than asthma or related to asthma, they may run other tests. […] Your health care provider may also check you for conditions such as: […] Exercise-induced bronchoconstriction (asthma) happens when the airways tighten and airflow gets obstructed (blocked) during or after exercise. […] It is not always clear what causes this type of asthma, but breathing in cold, dry air is a trigger. […] Diagnosing asthma in children under age 5 is a little different. […] The doctor may prescribe a bronchodilator if they think your child might have asthma. […] If the bronchodilator helps reduce your child’s symptoms, that is a sign that your child may have asthma.

• #1 Exercise-Induced Asthma Testing | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/pulmonology/patient-procedures/exercise-induced-asthma-testing

  Exercise-induced asthma (EIA) testing is a combination of several breathing, exercise and cardiology tests which will show how the heart and lungs work together during exercise. […] These tests can help determine if your child has exercise-induced asthma or some other kind of breathing problem during exercise. […] Exercise-induced asthma (EIA) testing, also called asthma challenge testing, actually consists of four separate tests combined into one to give doctors important information about how your childs lungs and heart are working together before, during and after exercise. […] The information from EIA testing can help the doctor understand your childs symptoms and decide how to treat them. […] The first test your child will have is a spirometry (spy-ROM-a-tree) test to check his or her lung or „pulmonary” function.

• #1 Exercise-induced Bronchoconstriction (EIB) | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/e/exercise-induced-bronchoconstriction

  Exercise-induced bronchoconstriction is caused by the narrowing of the small bronchial tubes in the lungs. […] A child that only has symptoms of asthma with exercise may have exercise-induced bronchoconstriction (EIB). […] How is exercise-induced bronchoconstriction diagnosed? […] A doctor will take a detailed history, asking questions about your family history of asthma and allergies. […] Your child’s doctor will complete a physical exam to test the function of your child’s lungs. […] A spirometry test is used to assess how well the lungs function when your child is at rest. […] Your child’s doctor may ask them to run outside or on a treadmill in the office for up to 10 minutes to increase your child’s breathing rate. […] Once your child’s diagnosis is made, their doctor will determine the best possible treatment plan. […] How can exercise-induced bronchoconstriction be prevented? […] For most children with EIB, proper diagnosis, treatment and prevention measures will allow your child to continue to remain active.

• #1 Is it exercise-induced asthma, or am I just out of shape?

  https://www.medicalnewstoday.com/articles/is-it-exercise-induced-asthma-or-am-i-just-out-of-shape

  Exercise-induced asthma can cause wheezing and shortness of breath. These are the same symptoms that a person may experience if they are out of shape. Because the conditions are so similar, only tests can determine which is present. […] Exercise-induced asthma, or exercise-induced bronchoconstriction (EIB), makes the bronchial tubes spasm during and after exercise. This makes breathing difficult. […] A key difference between the two conditions is that exercise-induced asthma often causes coughing, whereas simply being out of shape is unlikely to do so. The effects of EIB also tend to peak after exercise, while people who are out of shape typically notice that their symptoms rapidly improve after stopping exercise. […] A doctor may suspect EIB based on a persons physical history. For example, if the persons wheezing and breathlessness persist despite getting fitter, they may have exercise-induced asthma.

• #2 Exercise-Induced Asthma: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4174-exercise-induced-asthma

  Exercise-induced asthma happens when your airways get smaller during exercise, making it hard for you to breathe. […] Your provider will ask about your symptoms, including when you have them and how long they last. […] During an exercise challenge test (also called a bronchoprovocation test), you ride on a stationary bike or run on a treadmill. […] Treatment for exercise-induced asthma focuses on preventing and relieving symptoms. […] Your provider may prescribe medications you breathe in using an inhaler or a nebulizer. […] If you have asthma symptoms that start during or shortly after physical activity, you might have exercise-induced asthma. […] If you or your child has symptoms of EIB, call a healthcare provider. […] If you or your child has severe shortness of breath or trouble breathing, seek immediate medical attention.

• #2 Exercise-Induced Asthma: Symptoms, Causes, Treatment, Prevention

  https://www.healthline.com/health/asthma/exercise-induced-asthma

  Exercise-induced asthma happens when aerobic activity triggers these symptoms. Its also known as exercise-induced bronchoconstriction (EIB). With this condition, physical activity makes your airways contract and narrow, making it harder to breathe. […] EIB is common in people with asthma. But you can still develop EIB even if you dont have asthma. […] Treatment for exercise-induced asthma depends on your symptoms and overall health. Your doctor can help you develop a personalized treatment plan that works well for you. […] Possible treatment options include several different medications as well as breathing exercises. […] Your doctor may prescribe medication, such as: Short-acting beta-agonists (SABAs). SABAs, which are the first line of treatment, relax the lining of your airways. Its inhaled 5 to 20 minutes before exercise to prevent asthma symptoms.

• #2 Exercise-induced Bronchoconstriction (EIB) | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/e/exercise-induced-bronchoconstriction

  Exercise-induced bronchoconstriction is caused by the narrowing of the small bronchial tubes in the lungs. […] A child that only has symptoms of asthma with exercise may have exercise-induced bronchoconstriction (EIB). […] How is exercise-induced bronchoconstriction diagnosed? […] A doctor will take a detailed history, asking questions about your family history of asthma and allergies. […] Your child’s doctor will complete a physical exam to test the function of your child’s lungs. […] A spirometry test is used to assess how well the lungs function when your child is at rest. […] Your child’s doctor may ask them to run outside or on a treadmill in the office for up to 10 minutes to increase your child’s breathing rate. […] Once your child’s diagnosis is made, their doctor will determine the best possible treatment plan. […] How can exercise-induced bronchoconstriction be prevented? […] For most children with EIB, proper diagnosis, treatment and prevention measures will allow your child to continue to remain active.

• #2 Recognition and Management of Exercise-Induced Bronchospasm | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0215/p769.html

  Exercise-induced bronchospasm is an obstruction of transient airflow that usually occurs five to 15 minutes after physical exertion. […] Diagnosis is based on the results of a detailed history, including assessment of asthma triggers, symptoms suggestive of exercise-induced bronchoconstriction, and a normal forced expiratory volume at one second at rest. […] The diagnosis of EIB is based on a detailed history suggestive of shortness of breath, decreased exercise endurance, chest tightness, cough, or wheezing during or immediately following sustained exercise. […] Most patients with EIB have a normal physical examination, with no evidence of wheezing on auscultation. […] The most objective measure of EIB is a pulmonary function test coupled with an appropriate exercise challenge. […] If symptoms are strongly suggestive of EIB, a trial of therapy using a short-acting bronchodilator may be useful to see if the patient significantly improves in performance and symptoms. […] Failure to respond positively to these initial measures should prompt pulmonary function testing with a bronchodilator, exercise challenge testing and, possibly, referral to a specialist.

• #2 Exercise-induced bronchoconstriction – Wikipedia

  https://en.wikipedia.org/wiki/Exercise-induced_bronchoconstriction

  Exercise-induced bronchoconstriction (EIB) occurs when the airways narrow as a result of exercise. This condition has been referred to as exercise-induced asthma (EIA); however, this term is no longer preferred. While exercise does not cause asthma, it is frequently an asthma trigger. […] Exercise-induced bronchoconstriction can be difficult to diagnose clinically given the lack of specific symptoms and frequent misinterpretation as manifestations of vigorous exercise. There are many mimics that present with similar symptoms, such as vocal cord dysfunction, cardiac arrhythmias, cardiomyopathies, and gastroesophageal reflux disease. It is also important to distinguish those who have asthma with exercise worsening, and who consequently will have abnormal testing at rest, from true exercise-induced bronchoconstriction, where there will be normal baseline results. Because of the wide differential diagnosis of exertional respiratory complaints, the diagnosis of exercise-induced bronchoconstriction based on history and self-reported symptoms alone has been shown to be inaccurate and to result in an incorrect diagnosis more than 50% of the time. An important and often overlooked differential diagnosis is exercise-induced laryngeal obstruction (EILO). The latter can co-exist with EIB and is best differentiated using objective testing and continuous laryngoscopy during exercise (CLE) testing.

• #2 Exercise-Induced Bronchoconstriction: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0815/p427.html

  Exercise-induced bronchoconstriction describes the narrowing of the airway that occurs with exercise. More than 10 percent of the general population and up to 90 percent of persons previously diagnosed with asthma have exercise-induced bronchoconstriction. […] Spirometry should be performed initially to evaluate for underlying chronic asthma, although results are often normal. An empiric trial of short-acting beta2 agonists or additional bronchial provocation testing may be necessary to confirm the diagnosis. […] Self-reported symptoms alone should not be used to diagnose EIB. […] The exercise challenge test can accurately diagnose EIB. […] In patients with possible EIB, spirometry should be performed to rule out underlying asthma. Normal resting spirometry results are common in patients with EIB. If spirometry reveals an obstruction, additional testing before and after albuterol use is recommended.

• #2 Exercise-induced bronchoconstriction – Wikipedia

  https://en.wikipedia.org/wiki/Exercise-induced_bronchoconstriction

  Objective testing should begin with spirometry at rest. In true exercise-induced bronchoconstriction, the results should be within normal limits. Should resting values be abnormal, then asthma, or some other chronic lung condition, is present. There is, of course, no reason why asthma and exercise-induced bronchoconstriction should not co-exist but the distinction is important because without successful treatment of underlying asthma, treatment of an exercise component will likely be unsuccessful. If baseline testing is normal, some form of exercise or pharmacologic stress will be required, either on the sideline or practice venue, or in the laboratory. […] Treadmill or ergometer-based testing in lung function laboratories are effective methods for diagnosing exercise-induced bronchoconstriction, but may result in false negatives if the exercise stimulus is not intense enough.

• #2 Imitators of exercise-induced bronchoconstriction | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-5-7

  Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. […] The diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests. However, the presence of EIB can not be accurately determined on the basis of symptoms. […] Accurate diagnosis of EIB is essential. […] Therefore, confirmation of the diagnosis of EIB through standardized testing utilizing spirometry should be performed. Current guidelines (ATS, ERS, IOC-MC) for a diagnosis of EIB require a 10% or greater decrease in forced expiratory flow in the first second of exhalation (FEV1) in response to exercise or eucapnic voluntary hyperpnea (EVH). […] In summary, reported symptoms and history without objective lung function tests are not adequate to make a definitive diagnosis of EIB. It is therefore important to confirm a diagnosis of EIB through objective measures of lung function using standardized procedures.

• #2 Exercise-Induced Asthma Workup: Approach Considerations, Allergy and Infection Evaluation, Thyroid Function Evaluation

  https://emedicine.medscape.com/article/1938228-workup

  This requirement has resulted in new studies that have been used to validate some of these assessment tools, whether they are field challenges, treadmill testing, or new techniques such as eucapnic voluntary hyperventilation (EVH). […] At present, the USOC requires EIA to be diagnosed via EVH in order for preventive and treatment-related medications to be used in competition. […] This type of testing formalizes an aerobic challenge and provides an objective measure of the degree of bronchospasm that results from the exercise. […] Any drop from the baseline that is greater than or equal to 10%, on any postexercise measurement, indicates EIA. […] Severity of disease can be classified as follows: Mild – Decrease of 10-20% from baseline, Moderate – Decrease of 20-40% from baseline, Severe – Decrease of greater than 40% from baseline.

• #2 Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment

  https://www.mdpi.com/2077-0383/13/15/4558

  Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. EIB is diagnosed when FEV1 decreases ≥ 10% compared with pre-exercise baseline value and is classified as mild when the decrease is ≥10% but <25%, moderate when ≥25% but <50%, and severe when the fall is ≥50%. The exercise challenge test is a noninvasive test conducted in a real-life setting, usually in a controlled environment such as a pulmonary function testing laboratory or a clinic. The exercise challenge test is usually performed in an air-conditioned room with an ambient temperature between 20 and 25 °C. Maintaining low relative humidity, ideally 50% or less, helps prevent excessive moisture in the air, and keeping the inspired air relatively dry and below 25 °C aims at minimizing potential triggers for bronchoconstriction. The assessment of EIB severity consists of comparing pre-exercise FEV1 basal value with the lowest FEV1 value recorded at the specific intervals (5, 10, 15, and 30 min); this difference is then expressed as a percentage of the pre-exercise value. Indirect bronchoprovocation testing may represent a diagnostic option to establish EIB diagnosis. Indirect bronchial provocation tests use external stimuli like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) to cause the endogenous release of bronchoconstrictor mediators from airway inflammatory cells.

• #2 Exercise induced asthma test | CUH

  https://www.cuh.nhs.uk/patient-information/asthma-exercise-induced-test/

  There are some risks associated with all tests and medications. In some individuals, performing exercise may cause increased coughing during the test. If your airways are sensitive, the exercise may cause them to narrow. This may result in you feeling more wheezy, out of breath or tight chested than when you started the test. […] These complications are very rare; you will be questioned by your physiologist prior to the test to determine whether you are at increased risk.

• #2 Exercise-induced bronchoconstriction – Wikipedia

  https://en.wikipedia.org/wiki/Exercise-induced_bronchoconstriction

  Field-exercise challenge tests that involve the athlete performing the sport in which they are normally involved and assessing FEV1 after exercise are helpful if abnormal but have been shown to be less sensitive than eucapnic voluntary hyperventilation. […] The International Olympic Committee recommends the eucapnic voluntary hyperventilation (EVH) challenge as the test to document exercise-induced asthma in Olympic athletes. In the EVH challenge, the patient voluntarily, without exercising, rapidly breathes dry air enriched with 5% CO2 for six minutes. The presence of the enriched CO2 compensates for the CO2 losses in the expired air, not matched by metabolic production, that occurs during hyperventilation, and so maintains CO2 levels at normal. […] Medication challenge tests, such as the methacholine challenge test, have a lower sensitivity for detection of exercise-induced bronchoconstriction in athletes and are also not a recommended first-line approach in the evaluation of exercise-induced asthma.

• #2 Out of shape, or exercise-induced asthma? | Ohio State Health & Discovery

  https://health.osu.edu/wellness/exercise-and-nutrition/out-of-shape-or-exercise-induced-asthma

  It can be difficult for you to perceive the difference between being out of shape and having asthma. That’s why specialized tests can help doctors can diagnose you and find out if medication can help. […] To check specifically for exercise-induced asthma, tests may include specialized pulmonary function testing, electrocardiography, echocardiography, allergy testing or vocal cord tests, depending on your individual symptoms and history. […] The Ohio State Asthma Center also offers a rapid breathing test called Eucapnic Voluntary Hyperventilation (EVH). This is the International Olympic Committee’s preferred method for diagnosing exercise-induced asthma. […] The gold standard of exercised-induced asthma treatment is a prescription albuterol inhaler. You can carry it with you and use it about 15 to 20 minutes before exercise to prevent asthma symptoms. It’s an effective treatment for about 80 percent of exercise-induced asthma cases.

• #2 How to Diagnose Exercise Induced Asthma?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3289196/

  Exercise induced asthma (EIA) is a transient increase in airway resistance after intensive exercise and can be measured as a decline in forced expiratory volume in one second (FEV1). […] Several studies have shown that eucapnic voluntary hyperpnea challenge test (EVH test) is a very sensitive and specific diagnostic method. […] EIA can be diagnosed by several methods. However, there is a large variation in their quality and sensitivity, and their prices are rarely comparable. […] Methacholine challenge test is a direct test and is also used in the clinic to diagnose chronic asthma. […] The test is considered positive if the decline in FEV1 is greater than 20% from baseline value (FEV1 measurements at rest). […] The EVH test is an indirect challenge test, which reproduces EIA by hyperventilation of dry gas containing 5% CO2, 21% O2 and balanced N2.

• #2 Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-018-0098-2

  Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. […] Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common. […] To improve the rates of diagnosis of EIB in primary care, validated and widely accepted symptom-based questionnaires are needed that can accurately replicate the current diagnostic standards (forced expiratory volume in 1s reductions observed following exercise or bronchoprovocation challenge) in patients with and without asthma. […] The diagnosis of EIB in patients with and without asthma is multifactorial, leading to the condition often being either under- or over-diagnosed.

• #2 Exercise-Induced Asthma: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1938228-overview

  Imaging studies are often not indicated in the evaluation of routine exercise-induced asthma. […] Laryngoscopy can be performed to evaluate for foreign body or other obstruction in the upper airway. Postexercise laryngoscopy can be used to evaluate for vocal cord dysfunction, a condition often mistaken for exercise-induced asthma. […] The optimal treatment for exercise-induced asthma is to prevent symptomatic onset. After controlling the patient’s underlying and contributing factors (eg, respiratory infection, allergy, allergic asthma), a combination of drugs can be used to prevent this condition. […] The basis of treatment for exercise-induced asthma is with preexercise short-acting beta2-agonist administration. […] Patient education is a critical part of the treatment of EIA. Once the diagnosis is made, athletes should be encouraged to continue in their activities with the reassurance that proper treatment can allow for an unhampered performance for most individuals.

• #2 Asthma Diagnosis | AAFA.org

  https://aafa.org/asthma/asthma-diagnosis/

  To diagnose asthma, your doctor will talk to you about your personal and medical history. […] If you or your child are having problems breathing on a regular basis, visit a doctor (or other health care provider like a nurse practitioner) right away. […] For example, if you have a history of allergies or eczema, you have a higher chance of having asthma. […] This information can help your doctor make a diagnosis of asthma. […] The doctor may also ask if you get chest symptoms when you: […] Exercise […] To confirm asthma, your doctor may have you take one or more breathing tests known as lung function tests (also called pulmonary function tests). […] Lung function tests detect how well you inhale (breathe in) and exhale (breathe out) air from your lungs. […] If your lung function improves a lot with use of a bronchodilator, you could have asthma.

• #2 Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-018-0098-2

  A recent systematic review found insufficient evidence to support the widespread adoption of any existing EIB screening tools, and highlighted that there exists a substantial unmet need for a validated questionnaire. […] EIB should be considered when patients report respiratory symptoms that are induced by exercise. […] Diagnosis of EIB is confirmed based on specific changes in lung function provoked by exercise, rather than on the basis of symptoms. […] The American Thoracic Society (ATS) Clinical Practice Guidelines outline a decline in FEV1 of 10% from baseline after exercise or hyperpnoea challenge as confirmation of a positive EIB diagnosis. […] Many protocols recommend breathing dry air (10mg H2O/L) with a nose clip in place while completing an exercise challenge. […] While none of these bronchoprovocation tests are sensitive or specific to EIB, they all complement clinical history to identify airway hyperresponsiveness consistent with a diagnosis of EIB.

• #2 Exercise-Induced Asthma Treatment in Charlotte | CAAC

  https://www.carolinaasthma.com/exercise-induced-asthma/

  Distinguishing between EIA and other asthma types helps emphasize the importance of accurate diagnosis to ensure that individuals receive the appropriate guidance to effectively manage their symptoms. […] At Carolina Asthma Allergy Center, our allergists can run a battery of tests to confirm your diagnosis, including lung function tests and x-rays.

• #2 Exercise-Induced Asthma | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/exercise-induced-asthma/

  Exercise-induced asthma is a condition triggered by strong physical activity. […] Exercise-induced asthma, also called exercise-induced bronchospasm, is often diagnosed in children because of their high activity levels, but it can happen at any age. […] Your doctor will review your child’s medical history and perform a physical exam to diagnose exercise-induced asthma. […] Your doctor may also recommend lung function testing to help make the diagnosis. Lung function testing measures the ability to blow air out of the lungs before and after taking a medication to help relax the breathing tubes. The person performing the test may have your child exercise to bring on the symptoms.

• #2 Exercise-Induced Asthma Testing | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/pulmonology/patient-procedures/exercise-induced-asthma-testing

  Your child will be asked to walk briskly or jog on a treadmill. […] Your child also will repeat the spirometry breathing tests at 1 minute, 5 minutes, 10 minutes and 15 minutes after the exercise part of the test. […] Your child then will be given a bronchodilator inhaler to use, and a spirometry breathing test will be done again to see if the medication improves airflow.

• #2 Exercise-induced asthma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/symptoms-causes/syc-20372300

  Exercise-induced asthma is when the airways narrow or squeeze during hard physical activity. […] The medical term for this condition is exercise-induced bronchoconstriction (brong-koh-kun-STRIK-shun). […] Most people with exercise-induced bronchoconstriction can continue to exercise and remain active if they treat symptoms. Treatment includes asthma medicines and taking steps to prevent symptoms before physical activity starts. […] See your health care provider if you have symptoms of exercise-induced bronchoconstriction. A few conditions can cause similar symptoms, so it’s important to get a diagnosis as soon as you can. […] Exercise-induced bronchoconstriction is more likely to occur in: […] About 90% of people with asthma have exercise-induced bronchoconstriction. However, the condition also can occur in people without asthma. […] If not treated, exercise-induced bronchoconstriction can result in: […] Serious or life-threatening breathing difficulties, particularly among people with poorly managed asthma. […] Lower quality of life because of inability to exercise.

• #2 Is it exercise-induced asthma, or am I just out of shape?

  https://www.medicalnewstoday.com/articles/is-it-exercise-induced-asthma-or-am-i-just-out-of-shape

  Doctors use two tests to diagnose EIB: spirometry and bronchial provocation tests. […] According to a 2018 review article, exercise-induced asthma is under-diagnosed and frequently misdiagnosed. Many people assume that wheezing, coughing, and breathlessness are normal parts of exercise and either ignore their symptoms or avoid exercise. […] It is important to tell a doctor about any symptoms, especially if they persist. The doctor can evaluate the persons condition, carry out tests, and rule out other potential causes.

• #2 What Is Exercise Induced Asthma? | AAFA.org

  https://aafa.org/asthma/asthma-triggers-causes/exercise-induced-asthma/

  Everyone needs to exercise, even people with asthma! A strong, healthy body is one of your best defenses against disease. But some people have asthma episodes during exercise. This is called exercise-induced bronchoconstriction. By taking steps to control your asthma, you should be able to exercise free of symptoms. […] If you have asthma symptoms during exercise or physical activity, you may have exercise-induced bronchoconstriction (EIB). In the past, it was called exercise-induced asthma. But that name wrongly suggests that exercise causes asthma. […] As many as 90% of all people who have asthma also have EIB. You can also have EIB even if you do not have asthma. […] It is important to know the difference between being out of shape and having EIB. Your doctor will ask you about your medical history, family history, and may perform a series of tests to diagnose EIB. Your doctor may measure your breathing before, during, and after exercise to test your lung function.

• #2 Asthma and Exercise – Allergy & Asthma Network

  https://allergyasthmanetwork.org/what-is-asthma/asthma-exercise/

  What is exercise-induced asthma (EIA)? Exercise-induced bronchospasm (EIB) is sometimes also called exercise-induced asthma, or EIA. With EIB, airway muscle spasms constrict air flow. This may cause shortness of breath, coughing, wheezing, chest tightness and fatigue. These symptoms usually appear 5-10 minutes after exercise starts or ends. […] If you think you have EIB, make an appointment with a doctor. Your doctor will take your medical history and have you perform a breathing test. These breathing tests are performed after exercise and while resting. […] Exercise-induced asthma should not hold you back from exercise or participating in sports. However, it is important that your EIB is well-managed. You may need to make some lifestyle changes to manage your EIB. This may include avoiding environmental triggers and taking asthma medications.

• #3 Patient education: Exercise-induced asthma (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/exercise-induced-asthma-beyond-the-basics

  Exercise-induced asthma occurs when the airways narrow as a result of exercise. The preferred term for this condition is exercise-induced bronchoconstriction (EIB); exercise does not cause asthma, but is frequently an asthma trigger. […] A person may have asthma symptoms that become worse with exercise (more common) or may have only exercise-induced bronchoconstriction, without symptoms at other times. […] Typical symptoms are shortness of breath, chest tightness, and cough. Exercise-triggered symptoms typically develop 10 to 15 minutes after a brief episode of exercise or about 15 minutes into prolonged exercise. Symptoms typically resolve with rest over 30 to 60 minutes. […] Exercise-induced symptoms occur more commonly and are more intense when the inhaled air is cold, probably due to changes in the airways that are triggered by the large amounts of relatively cool, dry air inhaled during vigorous activity.

• #3 What is Exercise-Induced Asthma? Symptoms & Treatments | Asthma Allergy Centers in Southwest Michigan

  https://www.asthmaallergycenters.com/education/exercise-induced-asthma/

  In the United States, it is estimated that as many as 10% of school-age children experience asthma symptoms brought on or worsened by exercise. This is known as Exercise Induced Asthma (EIA). […] EIA can be difficult to diagnose. Patients who experience chest tightness, wheezing, shortness of breath or cough after exertion most likely have EIA. (But EIA should be explored whenever any symptoms appear regularly with exercise.) Symptoms usually peak 8 to 15 minutes after exercise ends. […] A diagnosis of EIA can be confirmed with an exercise challenge and spirometry testing. Spirometry is a test performed in the doctors office that measures the volume of air that can be forced out of the lungs in one second (called the FEV1). […] FEV1 that drops more than 10-15 percent after exertion indicates that the patient has EIA. […] Some patients are asked to measure their peak flow rates before and after exercise. Again, a significant decrease in airflow after exercise suggests EIA. […] If the bronchodilator relieves the symptoms and if treatment before exercise prevents symptoms, it is likely that the patient has EIA.

• #3 Exercise-Induced Asthma Testing | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/pulmonology/patient-procedures/exercise-induced-asthma-testing

  Your child will be asked to walk briskly or jog on a treadmill. […] Your child also will repeat the spirometry breathing tests at 1 minute, 5 minutes, 10 minutes and 15 minutes after the exercise part of the test. […] Your child then will be given a bronchodilator inhaler to use, and a spirometry breathing test will be done again to see if the medication improves airflow.

• #3 Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment

  https://www.mdpi.com/2077-0383/13/15/4558

  Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. EIB is diagnosed when FEV1 decreases ≥ 10% compared with pre-exercise baseline value and is classified as mild when the decrease is ≥10% but <25%, moderate when ≥25% but <50%, and severe when the fall is ≥50%. The exercise challenge test is a noninvasive test conducted in a real-life setting, usually in a controlled environment such as a pulmonary function testing laboratory or a clinic. The exercise challenge test is usually performed in an air-conditioned room with an ambient temperature between 20 and 25 °C. Maintaining low relative humidity, ideally 50% or less, helps prevent excessive moisture in the air, and keeping the inspired air relatively dry and below 25 °C aims at minimizing potential triggers for bronchoconstriction. The assessment of EIB severity consists of comparing pre-exercise FEV1 basal value with the lowest FEV1 value recorded at the specific intervals (5, 10, 15, and 30 min); this difference is then expressed as a percentage of the pre-exercise value. Indirect bronchoprovocation testing may represent a diagnostic option to establish EIB diagnosis. Indirect bronchial provocation tests use external stimuli like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) to cause the endogenous release of bronchoconstrictor mediators from airway inflammatory cells.

• #3 Exercise-Induced Asthma Workup: Approach Considerations, Allergy and Infection Evaluation, Thyroid Function Evaluation

  https://emedicine.medscape.com/article/1938228-workup

  Bronchoprovocation testing, as used with general asthma, methacholine, histamine, or cold air challenges, can be used to assess asthma. […] However, if the results are positive, they are indicative of asthma in general, not specifically EIA. […] A study of 46 children with exercise-induced asthma-like symptoms reported that a combination of the methacholine test, followed by the mannitol test, gives the highest return to identify bronchial hyper-responsiveness in children for the diagnosis of exercise-induced asthma or bronchospasm. […] Eucapnic voluntary hyperventilation (EVH) is a technique believed to be more sensitive and more accurate for diagnosing EIA.

• #3 What Is Exercise Induced Asthma? Symptoms, Tests & Medications

  https://www.emedicinehealth.com/exercise-induced_asthma/article_em.htm

  What Exams and Tests Diagnose Exercise-Induced Asthma? […] If you have had symptoms and are seeking medical care afterward, the health-care professional will ask questions and perform tests to search for and rule out or exclude other causes of the symptoms. The evaluation will almost certainly include tests of how well you can breathe at rest and may include tests during exertion. These tests are done at rest, after six to eight minutes of exercise, and then at regular intervals until at least 30 minutes after you have stopped exercising. Proper diagnosis is essential to ensure that the most appropriate treatment is given. […] In many instances, the history is the most important clue to the diagnosis of exercise-induced asthma. Oftentimes, armed with this information, the health-care professional will empirically trial a medication for exercise-induced asthma. Follow-up visits will then determine if this medication was effective in reducing the symptoms associated with exercise.

• #3 Exercise-Induced Bronchoconstriction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557554/

  Exercise-induced bronchoconstriction (EIB) describes a transient and reversible contraction of bronchial smooth muscle after physical exertion that may or may not produce symptoms of dyspnea, chest tightness, wheezing, and cough. […] Early detection, diagnosis confirmed by the change in lung function during exercise, and treatment can improve quality of life and, when managed appropriately, allows patients to participate freely in exercise without limiting competition at the elite level. […] Screening for EIB is not supported by quality evidence, and further research and development of a symptom measurement tool is needed. […] Clinical diagnosis by symptoms has low sensitivity and specificity, and some patients are asymptomatic. Standardized testing for diagnosis includes direct and indirect methods and usually involves spirometry measurement of FEV1 changes from baseline expressed as a percent decrease.

• #3 Asthma Diagnosis | AAFA.org

  https://aafa.org/asthma/asthma-diagnosis/

  Your doctor may prescribe a trial with asthma medicine to see if it helps. […] Most people with asthma have allergies that trigger or worsen their asthma. […] Your doctor may order blood tests to check your immune system. […] If your levels are high, this may be a sign of severe asthma. […] If your doctor thinks you have something other than asthma or related to asthma, they may run other tests. […] Your health care provider may also check you for conditions such as: […] Exercise-induced bronchoconstriction (asthma) happens when the airways tighten and airflow gets obstructed (blocked) during or after exercise. […] It is not always clear what causes this type of asthma, but breathing in cold, dry air is a trigger. […] Diagnosing asthma in children under age 5 is a little different. […] The doctor may prescribe a bronchodilator if they think your child might have asthma. […] If the bronchodilator helps reduce your child’s symptoms, that is a sign that your child may have asthma.

• #3 Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-018-0098-2

  A key consideration for physicians when a patient presents with symptoms of wheeze and shortness of breath triggered by exercise is whether a diagnosis of asthma with EIB or EIB alone is appropriate. […] The management of EIB in patients without asthma is very different from the management of patients who experience EIB in association with poorly controlled asthma. […] There is growing evidence that objectively confirmed EIB is more prevalent than would be assumed from using self-reported symptoms alone, possibly because a decline in lung function post exercise (the criterion for EIB) may occur in the absence of symptoms. […] Overall, current estimates reveal that approximately 70% of patients with asthma and EIB are diagnosed based on history and symptoms alone, and only 18% following exercise, medication or lung function testing.

• #3 Asthma and Exercise – Allergy & Asthma Network

  https://allergyasthmanetwork.org/what-is-asthma/asthma-exercise/

  What is exercise-induced asthma (EIA)? Exercise-induced bronchospasm (EIB) is sometimes also called exercise-induced asthma, or EIA. With EIB, airway muscle spasms constrict air flow. This may cause shortness of breath, coughing, wheezing, chest tightness and fatigue. These symptoms usually appear 5-10 minutes after exercise starts or ends. […] If you think you have EIB, make an appointment with a doctor. Your doctor will take your medical history and have you perform a breathing test. These breathing tests are performed after exercise and while resting. […] Exercise-induced asthma should not hold you back from exercise or participating in sports. However, it is important that your EIB is well-managed. You may need to make some lifestyle changes to manage your EIB. This may include avoiding environmental triggers and taking asthma medications.

• #3 Asthma and Exercise | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/managing-asthma/asthma-and-exercise

  Some people with asthma only have symptoms (e.g., shortness of breath, chest tightness, wheezing or coughing) during exercise or when doing physically demanding tasks. This is called exercise-induced asthma or exercise-induced bronchospasm. […] If you have asthma symptoms during or shortly after you exercise, be sure to talk to your doctor about it. Are you just out of shape? Is it exercise-induced asthma or poorly controlled asthma? You will need to work with your doctor to find out what type of asthma you have. You may benefit from different treatment options, like adding a daily controller medicine to your asthma treatment plan.

• #3 What Is Exercise Induced Asthma? | AAFA.org

  https://aafa.org/asthma/asthma-triggers-causes/exercise-induced-asthma/

  With a diagnosis and treatment plan, you can enjoy all types of physical activity. […] If you have EIB, your doctor will prescribe asthma medicine for you to take to help you manage your symptoms. Your doctor may prescribe a quick-relief medicine (usually in inhaler form). […] If you continue to have frequent symptoms with usual activity or exercise, talk with your doctor. Your doctor may adjust your asthma treatment plan to help your symptoms. […] It is important to talk with your health care provider before beginning any exercise program. […] Many Olympic athletes and professional athletes with EIB excel in their sports, when it is appropriately managed. […] While exercise cannot cure your asthma, some of its health benefits can help keep your asthma well-controlled.

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