Review Question - QID 215477

This patient requires occasional beta-2-agonist therapy for exercise-induced bronchospasm (EIB).

Exercise induced bronchospasm usually occurs in patients without an underlying diagnosis of asthma, although the two can occur concomitantly. It affects endurance athletes who participate in cold weather, outdoor sports most commonly, and usually occurs 10-15 minutes after the start of exercise with common complaints of shortness of breath, wheezing and persistent cough. Spirometry demonstrates FEV1 decrease >10% from baseline and eucapnic voluntary hyperventilation test is said to be the gold standard for diagnosis. Proper warm-up and beta-2-agonist inhaler, such as albuterol, are typically effective in treating this condition.

Weiler et al. describe exercise-induced bronchospasm as airway obstruction that occurs with exercise without regard to the presence of chronic asthma, but acknowledge EIB is a difficult condition to define. They go on to review evaluation and diagnosis of EIB as well as discussing various associated treatments at length.

Atchley et al. review EIB in the elite athlete with regards to its pathogenesis and evaluation. They note that the cause of EIB is likely attributable to environmental causes and airway hyperreactivity. They conclude by saying both symptoms and bronchoprovocative testing should be considered in evaluation and diagnosis of EIB.

Incorrect Answers:
Answer 1: Throat tightness and choking are more consistent with exercise-induced laryngeal obstruction, causing transient upper airway obstruction
Answer 2: FEV1/FVC ratio is decreased as FEV1 is usually reduced
Answer 4: EIB most commonly occurs in cold weather due to the cooling effects of the airway mucosa.
Answer 5: EIB causes lower airway obstruction, primarily expiratory in nature and does not affect the upper airway.