Pharmacological Advances in Managing Exercise-Induced Bronchospasm: An Umbrella Review Following PRIOR Guideline

This umbrella review systematically examines pharmacological strategies for exercise-induced bronchospasm (EIB), characterized by a transient airway narrowing post-exercise, often diagnosed by a ≥ 10% reduction in forced expiratory volume in 1 s. EIB is prevalent among elite athletes and individuals exposed to environmental triggers such as cold air and pollutants. Analyzing data from 10 systematic reviews, including 8 meta-analyses, evidence confirms the efficacy of treatments including β₂-adrenoceptor (AR) agonists, muscarinic antagonists, inhaled corticosteroids (ICS), leukotriene receptor antagonists (LTRA), and mast-cell stabilizers. β₂-AR agonists demonstrate significant protective effects despite concerns regarding long-term use, while combination therapies with ICS and LTRA provide additional benefits. A key proposal is the terminological distinction between EIB and "Exercise-Induced Asthma ATtack" (EIAAT), advocating for the use of EIAAT to identify asthma exacerbations during exercise in asthmatics and EIB characterized by bronchospasm in non-asthmatics, thus avoiding misdiagnosis in athletes and guiding appropriate management. The review highlights the promising role of ICS/formoterol in pre-exercise, as-needed, and Single Maintenance and Reliever Therapy (SMART) regimens, emphasizing the need for randomized controlled trials in athletes with EIB and EIAAT. Ensuring appropriate therapy access while maintaining integrity in competitive sports is pivotal, especially with evolving pharmacological options and anti-doping regulations.