Consultant. Vol. No.

February 3, 2011

Consultant.
Primary Care Update
Brief Summaries for Clinical Practice

Exercise and Asthma: Guidelines From the NIH

By Julie Bowen
Editor, ConsultantLive | February 3, 2011

Patients with asthma may be reluctant to exercise for fear of triggering an attack. You can reassure them
that adequate control can allow them to participate in almost any physical activity they wish.
Recommendations from the NIH offer guidance on prevention of exercise-induced bronchospasm.1
Highlights are presented here.

WHO’S AT RISK?
A history of cough, dyspnea, chest pain or tightness,
wheezing, or endurance problems during exercise suggests
exercise-induced bronchospasm; however, all patients with
asthma are at risk. To establish the diagnosis, order an
exercise challenge test. A 15% or greater decrease in peak
expiratory flow or forced expiratory volume in 1 second is
diagnostic.

TREATMENT OF EXERCISE-INDUCED BRONCHOSPASM

Adequate asthma control can enable patients to participate in almost any physical activity without
triggering symptoms. Frequent or severe exercise-induced bronchospasm may indicate the need to
initiate or step up the dosage of long-term control medications.

Pretreatment recommendations before exercise include the following1:

ÏInhaled beta2-agonists prevent exercise-induced bronchospasm in more than 80% of patients. A
short-acting beta2-agonist used just before exercise may be helpful for 2 to 3 hours. A long-acting beta 2
-agonist can be protective for up to 12 hours, but daily use shortens the duration of protection. Frequent
or long-term use of a long-acting beta2-agonist as pretreatment for exercise-induced bronchospasm is
discouraged because it may disguise poorly controlled persistent asthma.
ÏLeukotriene receptor antagonists, which have an onset of action generally hours after administration,
can attenuate exercise-induced bronchospasm in up to 50% of patients.
ÏCromolyn or nedocromil(Drug information on nedocromil) taken shortly before exercise is an
alternative treatment, but these agents are not as effective as short-acting beta2-agonists.
ÏA warmup period before exercise may reduce the degree of exercise-induced bronchospasm.
ÏA mask or scarf over the mouth may attenuate cold-induced exercise-induced bronchospasm.

PHYSICAL ACTIVITIES THAT POSE LEAST RISK

Certain activities may be less likely than others to trigger exercise-induced bronchospasm. Among those

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 Consultant. Vol. No. February 3, 2011

recommended by the American Academy of Allergy, Asthma, and Immunology are2:

ÏSwimming.
ÏWalking.
ÏBike riding.
ÏHiking.

Sports that require sustained activity, such as soccer and basketball, may be more likely to cause
symptoms than those that do not, such as baseball. Cold weather sports also pose greater risk of
exercise-induced bronchospasm than warm-weather activities.

REFERENCES:
1. National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR-3): Guidelines for the
Diagnosis and Management of Asthma. Bethesda, Md: NIH; 2007.
2. American Academy of Allergy, Asthma & Immunology. Tips to Remember: Asthma and Exercise.

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