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Dictionary of Allergies .. Exercise induced asthma

Exercise induced asthma

Exercise is a strong stimulus producing episode of wheezing in asthmatics. Aretaeus, described, in the second century a.c., asthma as follows: If from running, gymnastic exercise or any other work, the breathing becomes difficult, it is called asthma. Though the asthmatic does  become short of breath during exercise, much more importantly he becomes even more short of breath after exercise has ended (within 10 minutes after exercise). Instead of relaxation he finds that a rapidly progressive paroxysm of wheezing overtakes him. It reaches its peak within a few minutes and he may not recover for half an hour. Virtually no other type of chest disease is associated with breathlessness which gets worse immediately after exercise, so that this symptom is an extremely valuable guide to diagnosis.

Bronchodilators or cromolyn sodium may be used prophylactically. (See Exercise induced asthma). The prevalence of exercise-induced bronchospasm (EIB) is significantly higher in athletes than that in the general population and can result in significant morbidity in young, competitive athletes. Guidelines emphasize that education and written treatment protocols improve clinical outcomes for asthmatics. Evidence also supports objective testing when EIB is suspected, when there is immediate availability of rescue inhalers, and when there is involvement of asthma specialists in the care of asthmatic athletes. We sought to determine how EIB is managed at the National Collegiate Athletic Association (NCAA) sports medicine programs.


Existence of EIA among asthmatic children most strongly impairs their QoL.[2]. Exercise is the most common trigger of bronchospasm in children with asthma. Exercise-induced bronchoconstriction (EIB) occurs in up to 90% of individuals with asthma who are not under antiinflammatory treatment and in about 40% of those with allergic rhinitis. EIB may be an overwhelming problem in childhood and adolescence, when physical activity is a prominent component of daily life. The importance for those with asthma to maintain regular physical activity is recognized by asthma guidelines, which include the recommendation of full participation in sporting activities in their goals for the management of asthma. Cysteinyl leukotrienes, which are derivatives of the 5-lipoxygenase pathway of arachidonic acid metabolism, are important mediators of airway allergic inflammation and have a role in the pathogenetic mechanism of EIB. Montelukast sodium (Singulair, Merck & Co.) is a selective and orally active leukotriene receptor antagonist with demonstrated activity for treating asthma and allergic rhinitis. The effect of this drug in the prevention of EIB has been evaluated in a variety of studies in adults as well as in children.

Both single-dose and regular-treatment studies showed that montelukast provides effective protection against EIB. Furthermore, chronic treatment with montelukast does not induce tolerance to the bronchoprotective effect over time. This aspect is particularly relevant for children, who tend to be active at frequent and irregular intervals throughout the day, and who therefore may benefit from around-the-clock pharmacologic protection[3].

1. Parsons JP, Pestritto V, Phillips G, Kaeding C, Best TM, Wadley G, Mastronarde JG. Management of exercise-induced bronchospasm in NCAA athletic programs. Med Sci Sports Exerc. 2009 Apr;41(4):737-41.

2. Kojima N, Ohya Y, Futamura M, Akashi M, Odajima H, Adachi Y, Kobayashi F, Akasawa A. Exercise-Induced Asthma is Associated with Impaired Quality of Life Among Children with Asthma in Japan. Allergol Int. 2009 Jun;58(2):187-92. Epub 2009 Feb 25

3. de Benedictis FM, Vaccher S, de Benedictis D. Montelukast sodium for exercise-induced asthma. Drugs Today (Barc). 2008 Nov;44(11):845-55.

Γκέλης Ν.Δ. - Λεξικό Αλλεργίας - Εκδόσεις ΒΕΛΛΕΡOΦΟΝΤΗΣ - Κόρινθος 2013

Gelis Ν.D. - Dictionary of Allergies - VELLEROFONTIS Publications - Corinth 2013