Treatment of exercise induced asthma

• For most patients, exercise-induced asthma is an expression of poorly controlled asthma and regular treatment including inhaled corticosteroids should be reviewed
• If exercise is a specific problem in patients taking inhaled corticosteroids who are otherwise well-controlled, consider adding one of the following therapies:
  • leukotriene receptor antagonists
  • long-acting beta2 agonists
  • sodium cromoglicate or nedocromil sodium
  • theophyllines
• Immediately prior to exercise, inhaled short-acting beta2 agonists are the drug of choice.

Notes:

• a systematic review (2) revealed that inhaled corticosteroids used for 4 weeks or more before exercise testing significantly attenuated exercise-induced bronchoconstriction

Reference:

1. British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2019. British Guideline on the Management of Asthma. A national clinical guideline.
2. Koh MS et al. Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD002739.