Asthma in athletes: diagnostic challenges and management strategies

Exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA) are common conditions among athletes and represent an important clinical issue with potential implications for both respiratory health and athletic performance. The prevalence of asthma in athletes is higher than in the general population, likely due to the combined effects of increased ventilatory demand and environmental exposures.

The pathophysiology of EIB is multifactorial and involves osmotic and thermal mechanisms related to airway dehydration during exercise-induced hyperventilation. Although some athletes present a classical T2-high inflammatory phenotype associated with allergic sensitization, a considerable proportion develop EIB through non-T2 inflammatory pathways, including airway epithelial injury and autonomic dysregulation.

Diagnosis requires objective assessment through pulmonary function testing and bronchial provocation tests. Biomarkers like fractional exhaled nitric oxide (FeNO) and blood eosinophil counts can support phenotypic characterization, but they do not replace functional testing. Management in athletes follows established asthma guidelines and includes inhaled corticosteroids as the cornerstone of therapy, combined with pharmacological and non-pharmacological strategies. Considering anti-doping regulations is also essential to ensure appropriate treatment and compliance.