Review and Feature Article
Improving Screening and Diagnosis of Exercise-Induced Bronchoconstriction: A Call to Action

https://doi.org/10.1016/j.jaip.2013.11.001Get rights and content

This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis of exercise-induced bronchoconstriction (EIB), a transient airway narrowing that occurs during and most often after exercise in people with and without underlying asthma. EIB is both commonly underdiagnosed and overdiagnosed. EIB underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Routine use of a reliable and valid self-administered EIB screening questionnaire by professionals best positioned to screen large numbers of people could substantially improve the detection of EIB. The authors conducted a systematic review of the literature that evaluated the accuracy of EIB screening questionnaires that might be adopted for widespread EIB screening in the general population. Results of this review indicated that no existing EIB screening questionnaire had adequate sensitivity and specificity for this purpose. The authors present a call to action to develop a new EIB screening questionnaire, and discuss the rigorous qualitative and quantitative research necessary to develop and validate such an instrument, including key methodological pitfalls that must be avoided.

Section snippets

Prevalence and Burden of EIB

EIB is an acute bronchoconstriction triggered by exercise, which may occur in the presence of established asthma or in the absence of other features of chronic asthma.1, 2 Common symptoms of EIB include shortness of breath, wheezing, cough, and chest tightness during or immediately after exercise.1, 2 More subtle symptoms that may be suggestive of EIB include fatigue, feeling out of shape, feeling unable to keep up with peers, symptoms that occur repeatedly in specific environments (such as

Underdiagnosis

Research findings indicate that EIB is frequently underdiagnosed, possibly due to insufficient awareness of EIB and its burden and the lack of a questionnaire to screen effectively for this condition. Many individuals who report symptoms suggestive of EIB or who objectively test positive for EIB have never been formally diagnosed with EIB. In a general population survey, 26% of respondents reported experiencing respiratory symptoms with exercise, but only 5% had been diagnosed with EIB by a

Conclusion

EIB is a common condition that, when undiagnosed and untreated, may lead many individuals to forego regular exercise, which carries significant negative consequences. Detection of EIB early in life through screening may allow for early treatment, resulting in increased physical activity levels throughout life, improved cardiovascular conditioning, reduced rates of obesity, and better physical and emotional quality of life. Renewed efforts are needed to develop an EIB screening questionnaire by

References (40)

  • M.A. Krafczyk et al.

    Exercise-induced bronchoconstriction: diagnosis and management

    Am Fam Physician

    (2011)
  • J.P. Parsons et al.

    Impact of exercise-related respiratory symptoms in adults with asthma: Exercise-Induced Bronchospasm Landmark National Survey

    Allergy Asthma Proc

    (2011)
  • A.L. Cabral et al.

    Exercise-induced bronchospasm in children: effects of asthma severity

    Am J Respir Crit Care Med

    (1999)
  • J.V. West et al.

    Evaluation of bronchial responsiveness to exercise in children as an objective measure of asthma in epidemiological surveys

    Thorax

    (1996)
  • Y. Benarab-Boucherit et al.

    Prevalence rate of exercise-induced bronchoconstriction in Annaba (Algeria) schoolchildren

    J Asthma

    (2011)
  • S.D. Anderson et al.

    Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma

    Respir Res

    (2009)
  • D.A. Khan

    Exercise-induced bronchoconstriction: burden and prevalence

    Allergy Asthma Proc

    (2012)
  • T.S. Hallstrand et al.

    Quality of life in adolescents with mild asthma

    Pediatr Pulmonol

    (2003)
  • N.K. Ostrom et al.

    Exercise-induced bronchospasm in children with asthma in the United States: results from the Exercise-Induced Bronchospasm Landmark Survey

    Allergy Asthma Proc

    (2011)
  • J.I. Figueroa-Munoz et al.

    Association between obesity and asthma in 4-11 year old children in the UK

    Thorax

    (2001)
  • Cited by (21)

    • Exercise-induced bronchoconstriction in elite or endurance athletes:: Pathogenesis and diagnostic considerations

      2020, Annals of Allergy, Asthma and Immunology
      Citation Excerpt :

      Currently, there is a lack of an effective, validated screening questionnaire for EIB. This likely contributes to frequent underdiagnosis.70 However, overdiagnosis may occur when clinicians base their assessment on history alone without objective testing for accompanying BHR.2,3,70

    • Associations between obesity, asthma and physical activity in children and adolescents

      2020, Apunts Sports Medicine
      Citation Excerpt :

      It is characterized by breathlessness, wheezing, coughing, and chest tightness occurring during or after exercise. Asthmatic individuals react by avoiding exercise and physical activity due to a fear of experiencing EIB symptoms may be the best explanation for the lack of aerobic fitness.84 As a result, skeletal muscle deconditioning caused by hypoactivity may play a key in decreasing physical fitness levels.82

    • Exercise-induced bronchoconstriction update—2016

      2016, Journal of Allergy and Clinical Immunology
    • Management of Intermittent and Persistent Asthma in Adolescent and High School Athletes

      2020, Journal of Allergy and Clinical Immunology: In Practice
      Citation Excerpt :

      They may discount exercise-induced symptoms as due to bad conditioning or a poor training day. Furthermore, EIB/EIBa is frequently underdiagnosed because of lack of awareness among athletes and athletic trainers.71,72 This lack of awareness and subsequent misperception of symptoms may lead to unnecessary morbidity and potential mortality in college athletes.

    View all citing articles on Scopus

    Teva Pharmaceuticals sponsored the expert panel meeting, which led to this article, but had no role in the development of this article.

    Conflicts of interest: T. S. Hallstrand has received consultancy fees from Teva and Amgen; has received research support from the National Institutes of Health and Amgen; and has received lecture fees from Merck Schering Plough. J. P. Parsons has received consulting fees and travel support from Teva. C. Randolph has received consulting fees, travel support, payment for development of educational presentations from Teva; is on the American College of Allergy, Asthma & Immunology Board; has received lecture fees from AstraZeneca, Teva, Merck, GlaxoSmithKline, and Genentech; is a speaker for Med and Mylan; and is on the Teva Advisory Board. W. S. Silvers has received travel support and lecture fees from Teva. W. W. Storms has received consultancy and speaker's fees from Alcon, AstraZeneca, Bausch and Lomb, Merck; has received research support and consultancy fees from Amgen; has received research support and speaker's fees from Genentech/Novartis; has received research support from GlaxoSmithKline and Meda; has received research support, consultancy fees, and speaker's fees from Ista, Sunovion, and Teva; and has received consultancy fees from Strategic Pharmaceutical Advisors, and TREAT Foundation. J. M. Weiler has received consultancy fees and travel support from Teva and is employed by and owns stock/stock options in CompleWare Corporation. A. Bronstone is employed by BioMedEcon, LLC, which has received consultancy fees from Teva.

    View full text