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Related Experiment Videos

Mast-cell stabilising agents to prevent exercise-induced bronchoconstriction.

C H Spooner1, G R Spooner, B H Rowe

  • 1Division of Emergency Medicine, University of Alberta, 1G1.50 Walter Mackenzie Health Centre, 8440 - 112 ST, Edmonton, Alberta, Canada, T6G 2B7.

The Cochrane Database of Systematic Reviews
|October 30, 2003
PubMed
Summary

Short-acting beta-agonists (SABAs) are more effective than mast cell stabilizers (MCS) for preventing exercise-induced bronchoconstriction. While both drug classes and anticholinergics offer protection, SABAs provide superior attenuation of symptoms in asthmatic individuals.

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Area of Science:

  • Pulmonary Medicine
  • Pharmacology
  • Exercise Physiology

Background:

  • Exercise-induced bronchoconstriction (EIB) is a common condition affecting individuals with asthma, leading to symptoms like cough and dyspnea.
  • Current management strategies focus on pre-exercise pharmacological interventions to prevent EIB.
  • The comparative effectiveness of mast cell stabilizers versus bronchodilator agents for EIB prevention remains unclear.

Purpose of the Study:

  • To quantitatively compare the efficacy of mast cell stabilizers (nedocromil sodium, sodium cromoglycate) against short-acting beta-agonists (SABAs) and anticholinergic agents (atropine, ipratropium bromide) in preventing EIB.
  • To assess the effectiveness of SABA monotherapy versus a combination of SABA and mast cell stabilizer for EIB prevention.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).

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  • Searched multiple databases including Cochrane Airways Group ASTHMA and WHEEZ* trials register and Cochrane CENTRAL.
  • Included RCTs comparing prophylactic doses of mast cell stabilizers, SABAs, or anticholinergics in asthmatics aged 6+ with reproducible EIB, measuring pulmonary function changes (FEV1, peak flow).

    • Main Results:

    • Twenty-four trials involving 518 participants were analyzed. All agents demonstrated effectiveness in attenuating EIB.
    • Mast cell stabilizers showed greater efficacy than anticholinergic agents in reducing bronchoconstriction (7.1% fall vs. 13.8% fall).
    • Short-acting beta-agonists were more effective than mast cell stabilizers (4.3% fall vs. 11.2% fall), with a higher proportion achieving complete protection (85% vs. 66%).
    • Combination therapy of SABA and mast cell stabilizer did not offer significant advantages over SABA alone.

    Conclusions:

    • Short-acting beta-agonists, mast cell stabilizers, and anticholinergics effectively prevent exercise-induced bronchoconstriction with minimal adverse effects.
    • SABAs provide more effective attenuation of EIB compared to mast cell stabilizers, which are more effective than anticholinergics.
    • Individualized treatment selection is recommended due to variability in patient response to prophylactic therapies.