Exercise Induced Asthma: Difference between revisions
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== Medical Management (current best evidence)<br> == | == Medical Management (current best evidence)<br> == | ||
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'''Prevention:<br>American Academy of Allergy, Asthma, and Immunology (AAAAI) promotes utilization of self-management and prevention strategies for patients with asthma. A daily asthma management plan, as well as other information and resources, can be found on the AAAAI website.<ref name="Goodman">Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. W B Saunders Company; 2012.771</ref> <ref name="AAAI">The American Academy of Allergy, Asthma and Immunology. Accessed March 25, 2014 at http://www.aaaai.org/home.aspx</ref> | '''Prevention:<br>'''American Academy of Allergy, Asthma, and Immunology (AAAAI) promotes utilization of self-management and prevention strategies for patients with asthma. A daily asthma management plan, as well as other information and resources, can be found on the AAAAI website.'''<ref name="Goodman">Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. W B Saunders Company; 2012.771</ref> <ref name="AAAI">The American Academy of Allergy, Asthma and Immunology. Accessed March 25, 2014 at http://www.aaaai.org/home.aspx</ref>''' | ||
''' | '''Diagnosis:''''''<br>''' | ||
Exercise-Induced Bronchospasms (EIB) is often diagnosed based on the patient’s history of the following symptoms: cough, shortness of breath, chest pain or tightness, wheezing, or endurance problems during exercise. However, EIB has been shown to be misdiagnosed when based on patient history alone. Pulmonary function testing, involving a cardiovascular exercise challenge at 80% of heart rate maximum, is a primary diagnostic tool often used to augment clinical symptom findings. Diagnosis of EIB is indicated with 15-percent decrease in the patient’s PEF or FEV1<ref name="EPR3" />. | |||
''' | '''Management:''' | ||
If addressed and treated appropriately, exercise-induced asthma should not restrict one’s ability to fully participate in vigorous physical activity. Furthermore, adequate asthma control should allow for a patient to participate in any activity of choice without experiencing asthma symptoms<ref name="EPR3" />. Management of EIB should include identifying any allergens the patient may have, educating the patient on avoiding asthma triggers, and use of asthma medications, when necessary<ref name="Goodman" />. The EPR 3 Guidelines for Diagnosis and Management of Asthma recommend the following treatments for the medical management of EIA<ref name="EPR3">Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. SECTION 4, MANAGING ASTHMA LONG TERM—SPECIAL SITUATIONS. Accessed March 25, 2014 at http://www.nhlbi.nih.gov/guidelines/asthma.</ref>: | |||
'''Long-term Pharmacotherapy (if appropriate'''): <br>Anti-inflammatory medications, such as inhaled corticosteroids used to suppress airway inflammation, have been proven to decrease the frequency and severity of EIB when used on a daily basis for long-term control of asthma. Long-term control therapy is recommended for patients with poorly controlled symptoms, including frequent, severe episodes of EIB<ref name="EPR3" /><br> | |||
'''Treatments Prior to Exercise:''' | |||
'''1. Inhaled beta2-agonists'''<ref name="EPR3" />: | |||
*'''Short Acting Beta Agonists (SABA)''', often called ‘rescue inhalers’, are used acutely before exercise to control symptoms up to 2-3 hours | |||
*'''Long Acting Beta Agonists (LABA)''' are used in conjunction with inhaled corticosteroids to provide additional protection from asthma symptoms for up to 12 hours. LABA are not indicated for daily use but should be used as a pretreatment to exercise. | |||
'''2. Leukotriene Receptor Antagonists (LTRAs''')<ref name="EPR3" />: are medications used for allergy treatment and to prevent asthma symptoms. LTRAs have a longer onset of action and may take hours to provide symptom relief. | '''2. Leukotriene Receptor Antagonists (LTRAs''')<ref name="EPR3" />: are medications used for allergy treatment and to prevent asthma symptoms. LTRAs have a longer onset of action and may take hours to provide symptom relief. | ||
'''3. Exercise Warm Up'''<ref name="EPR3" />: A period of warming up before exercise may help to decrease symptoms associated with EIB | '''3. Exercise Warm Up'''<ref name="EPR3" />: A period of warming up before exercise may help to decrease symptoms associated with EIB | ||
'''4. Protection Against Cold'''<ref name="EPR3" />: Wearing a scarf over the mouth prior to/during activity may help to decrease cold-induced EIB <br><br> | |||
</div> | </div> | ||
Revision as of 20:43, 25 March 2014
Original Editors - Kaitlyn Stahl & A.J. Walsh from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Kaitlyn Stahl, Andrew Walsh, Lucinda hampton, Kim Jackson, 127.0.0.1, Elaine Lonnemann, WikiSysop, Laura Ritchie, Wendy Walker, Evan Thomas, Vidya Acharya and Kapil Narale
Definition/Description[edit | edit source]
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Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)
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Prevention:
American Academy of Allergy, Asthma, and Immunology (AAAAI) promotes utilization of self-management and prevention strategies for patients with asthma. A daily asthma management plan, as well as other information and resources, can be found on the AAAAI website.[1] [2]
'Diagnosis:'
Exercise-Induced Bronchospasms (EIB) is often diagnosed based on the patient’s history of the following symptoms: cough, shortness of breath, chest pain or tightness, wheezing, or endurance problems during exercise. However, EIB has been shown to be misdiagnosed when based on patient history alone. Pulmonary function testing, involving a cardiovascular exercise challenge at 80% of heart rate maximum, is a primary diagnostic tool often used to augment clinical symptom findings. Diagnosis of EIB is indicated with 15-percent decrease in the patient’s PEF or FEV1[3].
Management:
If addressed and treated appropriately, exercise-induced asthma should not restrict one’s ability to fully participate in vigorous physical activity. Furthermore, adequate asthma control should allow for a patient to participate in any activity of choice without experiencing asthma symptoms[3]. Management of EIB should include identifying any allergens the patient may have, educating the patient on avoiding asthma triggers, and use of asthma medications, when necessary[1]. The EPR 3 Guidelines for Diagnosis and Management of Asthma recommend the following treatments for the medical management of EIA[3]:
Long-term Pharmacotherapy (if appropriate):
Anti-inflammatory medications, such as inhaled corticosteroids used to suppress airway inflammation, have been proven to decrease the frequency and severity of EIB when used on a daily basis for long-term control of asthma. Long-term control therapy is recommended for patients with poorly controlled symptoms, including frequent, severe episodes of EIB[3]
Treatments Prior to Exercise:
1. Inhaled beta2-agonists[3]:
- Short Acting Beta Agonists (SABA), often called ‘rescue inhalers’, are used acutely before exercise to control symptoms up to 2-3 hours
- Long Acting Beta Agonists (LABA) are used in conjunction with inhaled corticosteroids to provide additional protection from asthma symptoms for up to 12 hours. LABA are not indicated for daily use but should be used as a pretreatment to exercise.
2. Leukotriene Receptor Antagonists (LTRAs)[3]: are medications used for allergy treatment and to prevent asthma symptoms. LTRAs have a longer onset of action and may take hours to provide symptom relief.
3. Exercise Warm Up[3]: A period of warming up before exercise may help to decrease symptoms associated with EIB
4. Protection Against Cold[3]: Wearing a scarf over the mouth prior to/during activity may help to decrease cold-induced EIB
Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
The most common differential diagnoses of EIB in athletes include[4]:
Vocal Cord Dysfunction
Laryngeal/tracheal processes
Respiratory tract infection
Gastro-esophageal reflux
Hyperventilation syndromes
Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. W B Saunders Company; 2012.771
- ↑ The American Academy of Allergy, Asthma and Immunology. Accessed March 25, 2014 at http://www.aaaai.org/home.aspx
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. SECTION 4, MANAGING ASTHMA LONG TERM—SPECIAL SITUATIONS. Accessed March 25, 2014 at http://www.nhlbi.nih.gov/guidelines/asthma.
- ↑ Schumacher Y, Pottgiesser T, Dickhuth H. Exercise-induced bronchoconstriction: Asthma in athletes. International Sportmed Journal [serial online]. December 2011;12(4):145-149. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed March 25, 2014.
