Diagnosis
Your doctor will conduct a medical exam to diagnose you of exercised-induced asthma. He or she will also order tests to assess your lung function and rule out other conditions that may be causing your symptoms. Your diagnosis may include:
Test of normal lung function- Your doctor will administer a spirometry test to assess how well your lungs function when you aren’t exercising. This test measures how much air you inhale, how much you exhale and how quickly you exhale.
Then, your doctor may give you an inhaled medication to open your lungs and repeat the test. The results of the two measurements are compared to see whether the bronchodilator improved your airflow. This initial lung function test is important for ruling out underlying chronic asthma as the cause of symptoms.
Exercise challenge tests- This is an additional test that enables your doctor to observe and assess symptoms. You may ask to run on a treadmill or use other stationary exercise equipment to increases your breathing rate and trigger the symptoms you’ve experienced.
Spirometry tests before and after the challenge can provide evidence of exercise-induced bronchoconstriction.
Alternate challenge tests- This test is an alternative to the exercise challenge. Your doctor may use an inhalation test that simulates the conditions that would likely trigger exercise-induced bronchoconstriction. If your airways respond to these stimuli, then the test should produce virtually the same lung function you have when exercising.
Again spirometry tests before and after the challenge test provide information about changes in lung function. These challenge tests include the following:
- Methacholine challenge, the use of an inhaled agent that interacts with certain smooth muscle cells in airways and results in bronchoconstriction
- Eucapnic voluntary hyperventilation (EVH) challenge, inhaling a mixture of dry air composed of oxygen, carbon dioxide and nitrogen that simulates the exchange of air when breathing is difficult
- Mannitol challenge, inhaling a dry powder that can trigger water loss on the surface of the airways and switch on molecular activity that controls inflammation — conditions that cause bronchoconstriction in people with oversensitive airways
Ruling out other conditions- Your doctor may order additional tests to rule out other conditions with symptoms similar to those of exercise-induced bronchoconstriction. These conditions include:
- Vocal cord dysfunction
- Allergies
- Lung disease
- Irregular heartbeats (arrhythmia) or other heart conditions
- Gastroesophageal reflux disease
Treatment
Your doctor may prescribe drugs to take shortly before exercise or to take daily for long-term control.
- Pre-exercise medications- These drugs are taken before exercise to minimize or prevent exercise-induced bronchoconstriction. Drugs in this group include the following:
- Short-acting beta agonists (SABAs) are inhaled drugs that help open airways. These are the most commonly used and generally most effective pre-exercise medications. Daily use of a SABA is not recommended, however, because you may develop a tolerance to its effect. These drugs include:
- Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
- Levalbuterol (Xopenex HFA)
- Pirbuterol (Maxair).
- Ipratropium (Atrovent HFA) is an inhaled medication that relaxes the airways and may be effective for some people. A generic version of ipratropium also can be taken with a nebulizer.
- Long-term control medications- Long-term drug may be prescribed by your doctor in addition to daily use of a pre-exercise medication. This manage the underlying chronic asthma or to manage symptoms when pre-exercise treatment alone isn’t effective. These medications, usually taken daily, include the following:
- Inhaled corticosteroids help suppress inflammation in your airways. You may need to take the drug two to four weeks before they will have maximum benefit. These medications include:
- Fluticasone (Flovent Diskus, Flovent Hfa)
- Budesonide (Pulmicort Flexhaler)
- Mometasone (Asmanex Twisthaler)
- Beclomethasone (Qvar)
- Combination inhalers contain a corticosteroid and a long-acting beta agonist (LABA), a drug that relaxes airways. While these inhalers are prescribed for long-term control, your doctor may recommend use prior to exercise. Combination inhalers include:
- Fluticasone And Salmeterol (Advair Diskus)
- Budesonide And Formoterol (Symbicort)
- Mometasone And Formoterol (Dulera)
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- Leukotriene modifiers are oral medications that may block inflammatory activity for some people. These drugs may be used daily or as a preventive treatment before exercise if taken at least two hours in advance. Examples include:
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo, Zyflo CR)
Don’t rely only on quick-relief medications it is better to ask your doctor for prescribed drugs and recommendations.
