Exercise-induced Asthma - Treatment

Treatment

As with any asthma, the best treatment is avoidance of conditions predisposing to attacks, when possible. In athletes who wish to continue their sport or do so at times in adverse conditions, preventive measures that can be taken include altered training techniques and medications.

Some athletes take advantage of the refractory period by precipitating an attack by "warming up," and then timing their competition such that it occurs during the refractory period. Step-wise training works in a similar fashion. An athlete warms up in stages of increasing intensity, using the refractory period generated by each stage to get up to a full workload.

Concerning medication, it should be recognized that treatment of EIB has been extensively studied in asthmatic subjects over the last 30 years, but not so in athletes with EIB. Thus, it is not known whether athletes with EIB or ‘sports asthma’ respond similarly to subjects with classical allergic or nonallergic asthma. However, there is no evidence supporting different treatment for EIB in asthmatic athletes and nonathletes.

The most common medication approach is to use a beta agonist about twenty minutes before exercise. Some physicians prescribe inhaled anti-inflammatory mists such as corticosteroids or leukotriene antagonists, and mast cell stabilizers have also proven effective. A randomized crossover study compared oral montelukast with inhaled salmeterol, both given two hours before exercise. Both drugs had similar benefit but montelukast lasted 24 hours.