Exercise and asthma: β2-agonists and the competitive athlete

Educational aims

1. Discuss the role of inhaled β-agonists in the management of exercise-induced asthma and exercise-induced bronchoconstriction.

2. Review the beneficial versus untoward effects of inhaled β-agonists on asthma, exercise-induced asthma and exercise-induced bronchoconstriction.

3. Report on current and past usage of these drugs by Olympic athletes.

Summary Inhaled β-agonists effectively block exercise-induced asthma/exercise-induced bronchoconstriction (EIA/EIB). They are the treatment of choice for this condition and are used by many elite and Olympic athletes. However, regular or frequent use of inhaled β-agonists leads to an increase in the underlying severity of EIA/EIB and a reduction in their bronchoprotective and bronchodilator effects, which means that they become less effective at preventing and treating EIA/EIB. Emphasis should be placed on preventative measures and anti-inflammatory treatments such as inhaled corticosteroids in order to minimise the need for inhaled β-agonists to prevent EIA/EIB.