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

Typical change in FEV₁ in response to an 8-minute exercise challenge in EIB-positive individuals. Note the small improvement in FEV₁ immediately after exercise followed by significant falls in FEV₁ at 5 minutes after the cessation of exercise. Spontaneous recovery is most often nearly complete by 30 minutes postchallenge. Recovery can be accelerated by administration of an inhaled β₂-agonist.

Eighteen of 23 elite winter athletes who tested positive by a field-based sport-specific exercise challenge but tested negative by laboratory treadmill run in ambient conditions of 21°C, 60% RH. Redrawn from Rundell KW, Wilber RL, Szmedra L, Jenkinson DM, Mayers LB, Im J. Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge. Med Sci Sports Exerc 2000;32:309-16.¹⁰ FEF_25-75, Forced expiratory flow at 25% to 75% of FVC.

EVH and exercise challenge (Exer) were performed by EIB-positive athletes at room temperature (22°C) inhaling dry medical-grade air at either room temperature (RT) or chilled (−1°C; CT). Falls in FEV₁ were not different between challenge modes or between inhaled air temperature conditions. This provides further evidence supporting the notion that inhaled air water content and not air temperature per se is the major trigger for the EIB response. Redrawn from Evans TM, Rundell KW, Beck KC, Levine AM, Baumann JM. Cold air inhalation does not affect the severity of EIB after exercise or eucapnic voluntary hyperventilation. Med Sci Sports Exerc 2005;37:544-9.³⁹

The hypertonic saline challenge provides a cumulative dose-response curve that can be used to define the severity of the EIB response. Redrawn from Anderson SD, Brannan JD. Methods for “indirect” challenge test including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols. Clin Rev Allergy Immunol 2003;24:27-54.⁶⁶

Similar to the hypertonic saline challenge, the cumulative dose-response curve obtained from the inhaled powder mannitol challenge can be used to define the severity of the response. Thus the efficacy of treatment can be monitored through serial challenges. Redrawn from Anderson SD, Brannan JD. Methods for “indirect” challenge test including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols. Clin Rev Allergy Immunol 2003;24:27-54.⁶⁶