Exercise-induced bronchospasm in the elite athlete.

Area of Science:

• Sports Medicine
• Pulmonology
• Exercise Physiology

Background:

• Exercise-induced bronchospasm (EIB) affects 10-50% of elite athletes, manifesting as acute airway narrowing during or after exercise.
• Airway drying due to high ventilation rates during exercise is the primary trigger for EIB.
• Prevalence is highest in winter sports due to chronic exposure to cold, dry air and indoor pollutants.

Purpose of the Study:

• To outline the pathophysiology and diagnosis of EIB in elite athletes.
• To highlight the importance of objective lung function testing for accurate diagnosis.
• To discuss current medical interventions and challenges in managing EIB.

Main Methods:

• Review of factors contributing to EIB, including exercise intensity, air quality, and individual predisposition.
• Emphasis on objective diagnostic measures: baseline spirometry and bronchial provocation tests.
• Discussion of diagnostic criteria, such as a 10% fall in FEV1 post-exercise.

Main Results:

• Airway dehydration leads to osmolarity changes, triggering inflammatory mediator release and bronchospasm.
• Histamine, leukotrienes, and prostanoids are implicated as key mediators.
• Standard pulmonary function testing before and after high-intensity dry air exercise is the recommended diagnostic approach.

Conclusions:

• Accurate EIB diagnosis relies on objective lung function tests, differentiating it from classic asthma.
• Medical interventions aim for symptom-free training and competition using daily controllers or pre-exercise prophylaxis.
• Effective EIB management in elite athletes remains challenging, necessitating tailored treatment strategies.