You are here

Exercise-Induced Asthma 493.8

 

synonyms: Exercise-Induced Asthma (EIA), Exercise-Induced Bronchospasm (EIB)

EIA ICD-9

  • 493.8 Other forms of asthma

EIA Etiology / Epidemiology / Natural History

  • Affects @20% of elite summer athletes and @45% of elite winter athletes.
  • Etiology: ariway dehydration, hypertonic airway fluid, inhaled irritants (chlorine/gas exhaust)
  • EIA = chronic asthma exacerbated by exercise
  • EIB = bronchospasm occuring only with exercise
  • Diagnosis: based on PFTs, PEFR, FEV1. Baseline drop that is greater than or equal to 10%, on any postexercise measurement, indicates EIA. Mild=10-20% decrease. Moderate=20-40% decrease. Severe=40% decrease.

EIA Anatomy

  • Airway narrowing is primarily caused by contraction of bronchial smooth muscle.

EIA Clinical Evaluation

  • Exercise induced cough, chest pain with exercise, fatigue with exercise, improvement in symptoms after warm up exercises.

EIA Xray / Diagnositc Tests

  • PFTs, PEFR, FEV1. Baseline drop that is greater than or equal to 10%, on any postexercise measurement, indicates EIA. Mild=10-20% decrease. Moderate=20-40% decrease. Severe=40% decrease.

EIA Classification / Treatment

  • Acute attack: PO/IV corticosteriods 60-80 mg er day for 5 days followed by steriod taper or Methylprednisolone 0.5-2.0mb/kg Q6hrs. Consider epinephrine 0.3ml of 1:1000 solution; albuterol 4-8 puffs Q20minutes x3; supplemental oxygen for severe acute attacks.
  • Warmup with low-intensity exercise before practice or competition, inhaled beta-2 adrenoceptor agonists. Fish oils (contain eicosapentaenoic and docosahexaenoic acids) have anti-inflammatory affects which are often helpful for EIB (Mickleborough TD, Chest 2006;29:39). Fish oil diet = 20 capsules per day of a triglyceridic oil containing approximately 18% EPA (EPAX 3000 TG; Pronova Biocare; Lysaker, Norway; 160 mg of EPA per gram of triglyceride) and 12% DHA (100 mg of DHA per gram of triglyceride), with 1 to 2 mg of tocopherol per gram of triglyceride added, in 1,000-mg soft gel capsules (Mickleborough TD, Chest 2006;29:39).
  • Salbutamol 20 minutes before exercise and prn (Short acting).
  • Salmeterol or Formoterol 1 hour before exercise (long acting).
  • Lekotrine antagonists (montelukast, zafirlukast): prevent last cell degranuation.
  • Consider Nedocromil or cromolyn sodium
  • Consider: antihistamines for associated seasonal allergies, immunotherapy for specific antigens.
  • IOC mandates laboratory documented reduced FEV1 for approval for athletes to use beta-agonists.

EIA Associated Injuries / Differential Diagnosis

  • Vocal cord dysfunction (inspiratory stripor with exercise that resolves with rest) (Parker JM, Clin Chest Med 2004;25:321).
  • Cardiac disease
  • Airway obstruction
  • Pulmonary disease

EIA Complications

  • Asthmatic attack

EIA Follow-up Care

  • Generally referred to primary care or pulmonary for continued management.

EIA Review References

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer