What are the typical symptoms of exercise-induced bronchoconstriction (EIB) (exercise-induced asthma [EIA])?

Updated: Nov 20, 2020
  • Author: Michael J Morris, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In patients with exercise-induced bronchoconstriction, the clinical history findings are typical of asthma but are associated only with exercise. Typical symptoms include cough, wheezing, shortness of breath, and chest pain or tightness. Some individuals also may report sore throat or GI upset. Initially, airway dilation is noted during exercise. If exercise continues beyond approximately 10 minutes, bronchoconstriction supervenes, resulting in asthma symptoms. If the exercise period is shorter, symptoms may develop up to 5-10 minutes after completion of exercise. Higher intensity levels of exercise result in a more intense attack, with running producing more symptoms than walking.

Patients may note asthma symptoms are related to seasonal changes or the ambient temperature and humidity in the environment in which a patient exercises. Other triggers may be pollutants (eg, sulfur, nitrous oxide, ozone) or upper respiratory tract infections. Cold, dry air generally provokes more obstruction than warm, humid air. Consequently, many athletes have good exercise tolerance in sports such as swimming. A prospective longitudinal study in Britain found that swimming was associated with increased lung function and lower risk of asthma-related symptoms, especially among children with respiratory conditions. [44]

Athletes who are more physically fit may not notice the typical asthma symptoms and may report only a reduced or more limited level of endurance. Several modifiers in the history should prompt an evaluation for causes other than exercise-induced bronchoconstriction. While patients may report typical obstructive symptoms, a history of a choking sensation with exercise, inspiratory wheezing, or stridor should prompt an evaluation for evidence of vocal cord dysfunction.

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