ATS drafts guidelines for better EIB treatment

New guidelines have been set and released by the American Thoracic Society on the topic of exercise-induced bronchoconstriction (EIB).

According to the society and the recommendation drafters, EIB is prevalent in not only patients with asthma, but also those without additional respiratory conditions. Prevalence EIB is estimated to be as high as 20 percent in non-asthmatic patients, and anywhere from 30-70 percent common in athletes of even Olympic and elite qualifications.

"While a large proportion of asthma patients experience exercise-induced respiratory symptoms, EIB also occurs frequently in subjects without asthma," said Jonathan Parsons, MD, associate professor of internal medicine and associate director of The Ohio State University Asthma Center and chair of the committee that drafted the statement, in a news release. "To provide clinicians with practical guidance for the treatment of EIB, a multidisciplinary panel of stakeholders was convened to review the pathogenesis, diagnosis and treatment of EIB to develop these evidence-based guidelines."

Among the treatment suggestions is the use of short-acting beta-agonists before exercise or activity — for those EIB patients who continue to weather symptoms after beta-agonist application, the drafters recommend a daily inhaled corticosteroid, a daily leukotriene receptor antagonist or a mast cell stabilizing agent before aerobic strain. Every person with EIB should participate in warm-up activity before more rigorous movement, the analysts insist.

"Given the high prevalence of EIB, evidence-based guidelines for its management are of critical importance," Parsons added. "These new guidelines address not only the diagnosis and management of EIB but address other important issues related to EIB, including environmental triggers and special considerations in elite athletes."

Due to environmental EIB triggers such as cold air, dry air, ambient ozone and airborne particulate matter, physicians are encouraged to question patients who ice skate, ski, swim and run long distances regarding any possible upset to their routine that could be symptomatic of EIB. Moreover, for patients who participate in such sports competitively, certain treatment for EIB is oftentimes banned and thus, physicians will need to curb alleviants to align with sporting regulations whilst still promoting their patient’s health.

"While EIB is common, there are effective treatments and preventive measures, both pharmacological and non-pharmacological," said Parsons. "The recommendations in these guidelines synthesize the latest clinical evidence and will help guide the management of EIB in patients with or without asthma and in athletes at all levels of competition."

The regulations were published in the latest edition of the American Journal of Respiratory and Critical Care Medicine, released May 1.