EXERCISE-INDUCED BRONCHOCONSTRICTION: PATHOGENESIS, SYMPTOMS, DIAGNOSIS AND CURRENT TREATMENT - LITERATURE REVIEW
Abstract
Objective: Exercise-induced bronchoconstriction (EIB) is a reversible narrowing of the airways that occurs during or shortly after physical exertion, affecting both individuals with asthma and those without prior respiratory diagnoses. EIB is particularly prevalent among athletes and individuals exposed to cold, dry air or environmental pollutants. This article aims to present an updated review of EIB, focusing on its underlying mechanisms, clinical symptoms, diagnostic approaches, and current treatment options.
Methods: A comprehensive review of recent literature was conducted, examining the pathophysiology, clinical manifestations, diagnostic criteria, and management strategies of EIB. The search incorporated studies addressing both pharmacological and non-pharmacological interventions, as well as diagnostic methodologies such as spirometry and bronchial provocation tests.
Key findings: EIB primarily results from airway dehydration and cooling during exercise, triggering the release of inflammatory mediators like leukotrienes and prostaglandins that cause bronchoconstriction. Patients typically experience symptoms including shortness of breath, wheezing, cough, and chest tightness, which can severely impact exercise performance and quality of life. Diagnosis is best established through objective lung function testing, with a fall in FEV1 by 10% or more after exercise being indicative of EIB. Inhaled short-acting β2-agonists remain the cornerstone of treatment, while inhaled corticosteroids and leukotriene receptor antagonists serve as adjunct therapies in cases with underlying asthma or persistent symptoms.
Conclusions: Accurate diagnosis and tailored management are essential to enable individuals with EIB to engage safely in physical activities. Combining pharmacological treatments with lifestyle modifications provides effective symptom control. Ongoing research is warranted to refine diagnostic tools and optimize therapeutic protocols to further improve outcomes for affected individuals.
References
Parsons JP, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am. J. Respir. Crit. Care Med. 2013;187:1016–1027. https://doi.org/10.1164/rccm.201303-0437st
Weiler JM, et al. Improving screening and diagnosis of exercise-induced bronchoconstriction: a call to action. J. Allergy Clin. Immunol. Pract. 2014;2:275–280.e277. https://doi.org/10.1016/j.jaip.2013.11.001
Atchley TJ, Smith DM. Exercise-induced bronchoconstriction in elite or endurance athletes:: Pathogenesis and diagnostic considerations. Ann Allergy Asthma Immunol. 2020 Jul;125(1):47-54. Epub 2020 Feb 6. PMID: 32035936. https://doi.org/10.1016/j.anai.2020.01.023
Jayasinghe H, Kopsaftis Z, Carson K. Asthma Bronchiale and Exercise-Induced Bronchoconstriction. Respiration. 2015;89(6):505-12. Epub 2015 Jun 11. PMID: 26068579. https://doi.org/10.1159/000433559
Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports. 2024; 34:e14358. https://doi.org/10.1111/sms.14358
Anderson SD, Daviskas E. The mechanism of exercise-induced asthma is .. J Allergy Clin Immunol. 2000 Sep;106(3):453-9. PMID: 10984363. https://doi.org/10.1067/mai.2000.109822
Anderson SD, Argyros GJ, Magnussen H, Holzer K. Provocation by eucapnic voluntary hyperpnoea to identify exercise induced bronchoconstriction. Br J Sports Med. 2001 Oct;35(5):344-7. PMID: 11579071; PMCID: PMC1724385. https://doi.org/10.1136/bjsm.35.5.344
Anderson SD. Is there a unifying hypothesis for exercise-induced asthma? J Allergy Clin Immunol. 1984 May;73(5 Pt 2):660-5. PMID: 6715730. https://doi.org/10.1016/0091-6749(84)90301-4
Carlsen KH, Anderson SD, Bjermer L, Bonini S, Brusasco V, Canonica W, Cummiskey J, Delgado L, Del Giacco SR, Drobnic F, Haahtela T, Larsson K, Palange P, Popov T, van Cauwenberge P; European Respiratory Society; European Academy of Allergy and Clinical Immunology. Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN. Allergy. 2008 Apr;63(4):387-403. PMID: 18315727. https://doi.org/10.1111/j.1398-9995.2008.01662.x
Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, Rundell KW, Silvers WS, Storms WW, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Spector SL, Tilles SA, Wallace D, Henderson W, Schwartz L, Kaufman D, Nsouli T, Shieken L, Rosario N; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol. 2010 Dec;105(6 Suppl):S1-47. PMID: 21167465. https://doi.org/10.1016/j.anai.2010.09.021
Khan DA. Exercise-induced bronchoconstriction: burden and prevalence. Allergy Asthma Proc. 2012 Jan-Feb;33(1):1-6. PMID: 22370526. https://doi.org/10.2500/aap.2012.33.3507
Dreßler, M., Friedrich, T., Lasowski, N. et al. Predictors and reproducibility of exercise-induced bronchoconstriction in cold air. BMC Pulm Med 19, 94 (2019). https://doi.org/10.1186/s12890-019-0845-3
Aggarwal, B., Mulgirigama, A. & Berend, N. Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. npj Prim Care Resp Med 28, 31 (2018). https://doi.org/10.1038/s41533-018-0098-2
PARSONS, JONATHAN P.; KAEDING, CHRISTOPHER; PHILLIPS, GARY; JARJOURA, DAVID; WADLEY, GAIL; MASTRONARDE, JOHN G.. Prevalence of Exercise-Induced Bronchospasm in a Cohort of Varsity College Athletes. Medicine & Science in Sports & Exercise 39(9):p 1487-1492, September 2007. https://doi.org/10.1249/mss.0b013e3180986e45
Klain A, Indolfi C, Dinardo G, Contieri M, Decimo F, Miraglia Del Giudice M. Exercise-Induced Bronchoconstriction in Children. Front Med (Lausanne). 2022 Jan 3;8:814976. PMID: 35047536; PMCID: PMC8761949. https://doi.org/10.3389/fmed.2021.814976
Smoliga JM, Weiss P, Rundell KW. Exercise induced bronchoconstriction in adults: evidence based diagnosis and management. BMJ 2016;352:h6951. https://doi.org/10.1136/bmj.h6951
Serly, V., Basyar, M. ., & Herman, D. . (2025). Exercise-Induced Asthma: Challenges of Exercise and Management. Eduvest - Journal of Universal Studies, 5(3), 3091–3108. https://doi.org/10.59188/eduvest.v5i3.43688
Weiler JM, Brannan JD, Randolph CC, Hallstrand TS, Parsons J, Silvers W, Storms W, Zeiger J, Bernstein DI, Blessing-Moore J, Greenhawt M, Khan D, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Tilles SA, Wallace D. Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol. 2016 Nov;138(5):1292-1295.e36. Epub 2016 Sep 21. PMID: 27665489. https://doi.org/10.1016/j.jaci.2016.05.029
Billen A, Dupont L. Exercise induced bronchoconstriction and sports. Postgrad Med J 2008;84:512–517. https://doi.org/10.1136/pgmj.2007.067504
Anderson SD, Kippelen P. Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes. J Allergy Clin Immunol. 2008 Aug;122(2):225-35; quiz 236-7. Epub 2008 Jun 12. PMID: 18554705. https://doi.org/10.1016/j.jaci.2008.05.001
Bougault V, Turmel J, Boulet LP. Airway hyperresponsiveness in elite swimmers: is it a transient phenomenon? J Allergy Clin Immunol. 2011 Apr;127(4):892-8. Epub 2010 Dec 16. PMID: 21167573. https://doi.org/10.1016/j.jaci.2010.11.003
Rundell KW, Jenkinson DM. Exercise-induced bronchospasm in the elite athlete. Sports Med. 2002;32(9):583-600. PMID: 12096931. https://doi.org/10.2165/00007256-200232090-00004
Del Giacco SR, Carlsen KH, Du Toit G. Allergy and sports in children. Pediatr Allergy Immunol. 2012 Feb;23(1):11-20. PMID: 22283403. https://doi.org/10.1111/j.1399-3038.2011.01256.x
Kippelen P, Anderson SD. Airway injury during high-level exercise. Br J Sports Med. 2012 May;46(6):385-90. Epub 2012 Jan 12. PMID: 22247295. https://doi.org/10.1136/bjsports-2011-090819
Sue-Chu M. Winter sports athletes: long-term effects of cold air exposure. Br J Sports Med. 2012 May;46(6):397-401. Epub 2012 Jan 20. PMID: 22267570. https://doi.org/10.1136/bjsports-2011-090822
Dickinson JW, et al. Misdiagnosis of exercise-induced bronchoconstriction in professional athletes. Allergy. 2012;67:390–395. https://doi.org/10.1111/j.1398-9995.2011.02762.x
Hallstrand TS, Curtis JR, Aitken ML, Sullivan SD. Quality of life in adolescents with mild asthma. Pediatr Pulmonol. 2003 Dec;36(6):536-43. PMID: 14618647; PMCID: PMC2002508. https://doi.org/10.1002/ppul.10395
Price OJ, Hull JH, Ansley L, Thomas M, Eyles C. Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception. Respir Physiol Neurobiol. 2016 Nov 7;227:63-70. https://doi.org/10.1016/j.rmed.2016.09.017
Lang DM, Butz AM, Duggan AK, Serwint JR. Physical activity in urban school-aged children with asthma. Pediatrics. 2004 Apr;113(4):e341-6. PMID: 15060265. https://doi.org/10.1542/peds.113.4.e341
Hull JH, et al. Approach to the diagnosis and management of suspected exercise-induced bronchoconstriction. BMC Pulm Med. 2009;9:29. https://doi.org/10.1186/1471-2466-9-29
Grandinetti R, Mussi N, Rossi A, Zambelli G, Masetti M, Giudice A, Pilloni S, Deolmi M, Caffarelli C, Esposito S, Fainardi V. Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment. J Clin Med. 2024 Aug 5;13(15):4558. PMID: 39124824; PMCID: PMC11312884. https://doi.org/10.3390/jcm13154558
Leahy MG, Peters CM, Geary CM, Koehle MS, McKenzie DC, Brotherhood J, Sheel AW. Diagnosis of Exercise-induced Bronchoconstriction in Swimmers: Context Matters. Med Sci Sports Exerc. 2020 Sep;52(9):1855-1861. PMID: 32175977. https://doi.org/10.1249/mss.0000000000002335
Sarah Koch, Sean Michael Sinden, Michael Stephen Koehle - Inconsistent calculation methodology for the eucapnic voluntary hyperpnoea test affects the diagnosis of exercise-induced bronchoconstriction: BMJ Open Respiratory Research 2018;5:e000358. https://doi.org/10.1136/bmjresp-2018-000358
Hengeveld VS, Keijzer PB, Diamant Z, Thio BJ. An Algorithm for Strategic Continuation or Restriction of Asthma Medication Prior to Exercise Challenge Testing in Childhood Exercise Induced Bronchoconstriction. Front Pediatr. 2022 Feb 22;10:800193. PMID: 35273926; PMCID: PMC8902070. https://doi.org/10.3389/fped.2022.800193
Malewska-Kaczmarek K, Bobeff K, Mańkowski T, Podlecka D, Jerzyńska J, Stelmach I. Adolescent Athletes at Risk of Exercise-Induced Bronchoconstriction: A Result of Training or Pre-Existing Asthma? Int J Environ Res Public Health. 2022 Jul 26;19(15):9119. PMID: 35897509; PMCID: PMC9367722. https://doi.org/10.3390/ijerph19159119
Bhatia R, Abu-Hasan M, Weinberger M. Exercise-Induced Dyspnea in Children and Adolescents: Differential Diagnosis. Pediatric Annals. 2019;48(3):e121-e127. https://doi.org/10.3928/19382359-20190219-02
Ansley L, Rae G, Hull JH. Practical approach to exercise-induced bronchoconstriction in athletes. Prim Care Respir J. 2013 Mar;22(1):122-5. PMID: 23443223; PMCID: PMC6442764. https://doi.org/10.4104/pcrj.2013.00004
Bougault V, Turmel J, St-Laurent J, Bertrand M, Boulet LP. Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes. Eur Respir J. 2009 Apr;33(4):740-6. Epub 2009 Jan 7. PMID: 19129276. https://doi.org/10.1183/09031936.00117708
Stickland MK, Rowe BH, Spooner CH, Vandermeer B, Dryden DM. Effect of warm-up exercise on exercise-induced bronchoconstriction. Med Sci Sports Exerc. 2012 Mar;44(3):383-91. PMID: 21811185. https://doi.org/10.1249/mss.0b013e31822fb73a
Bonini M, Palange P. Exercise-induced bronchoconstriction: new evidence in pathogenesis, diagnosis and treatment. Asthma Res Pract. 2015 Jul 2;1:2. PMID: 27965757; PMCID: PMC4970375. https://doi.org/10.1186/s40733-015-0004-4
Molis MA, Molis WE. Exercise-induced bronchospasm. Sports Health. 2010 Jul;2(4):311-7. PMID: 23015953; PMCID: PMC3445098. https://doi.org/10.1177/1941738110373735
Carlsen KH, Hem E, Stensrud T. Asthma in adolescent athletes. Br J Sports Med. 2011 Dec;45(16):1266-71. PMID: 22117018. https://doi.org/10.1136/bjsports-2011-090591
Mickleborough TD, Lindley MR, Ionescu AA, Fly AD. Protective effect of fish oil supplementation on exercise-induced bronchoconstriction in asthma. Chest. 2006 Jan;129(1):39-49. PMID: 16424411. https://doi.org/10.1378/chest.129.1.39
Mickleborough TD, Murray RL, Ionescu AA, Lindley MR. Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med. 2003 Nov 15;168(10):1181-9. Epub 2003 Aug 6. PMID: 12904324. https://doi.org/10.1164/rccm.200303-373oc
Dickinson J, Amirav I, Hostrup M. Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction. Immunol Allergy Clin North Am. 2018 May;38(2):245-258. PMID: 29631733. https://doi.org/10.1016/j.iac.2018.01.012
Views:
32
Downloads:
12
Copyright (c) 2025 Izabela Szczap, Adam Żuczek, Olga Żuczek, Kinga Dyndał, Marcelina Broda, Katarzyna Urbańska, Anna Hawryluk, Kamil Marzec, Aleksandra Mokrzycka, Patrycja Jędrzejewska-Rzezak
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
