Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes

The prevalence of exercise-induced bronchoconstriction is reported to be high among recreational and elite athletes, yet diagnosis is often symptom-based. Indirect challenges such as the laboratory exercise challenge provide objective criteria for proper diagnosis and treatment. However, a standardized protocol using appropriate exercise intensity, duration, and dry air inhalation is often not implemented, and thus a false-negative test may result. This article reviews and describes the symptom-based diagnosis, the exercise challenge, and other indirect challenges such as eucapnic voluntary hyperpnea, hypertonic saline inhalation, and inhaled powdered mannitol as methods to diagnose and evaluate exercise-induced bronchoconstriction. Advantages and disadvantages of each diagnostic procedure are presented.

Key words: Athlete, bronchoconstriction, diagnosis, EVH, exercise-induced asthma, hypertonic saline, mannitol

Abbreviations used: ATS, American Thoracic Society, EIB, Exercise-induced bronchoconstriction, EVH, Eucapnic voluntary hyperpnea, FVC, Forced vital capacity, HR_peak, Peak heart rate, ICS, Inhaled corticosteroid, IOC, International Olympic Committee, MVV, Maximal voluntary ventilation, RH, Relative humidity, V_E, Minute ventilation