Diagnosis and treatment of exercise-induced asthma

Exercise-induced asthma (EIA) is a frequent presentation in asthma and represents a major obstacle to normal daily activities in many asthmatic children. Mastering EIA is an important part of mastering asthma. Proper diagnosis is a requisite for correct treatment of EIA. There are several differential diagnoses that do not respond to the usual treatment for EIA. EIA is best diagnosed using a standardized exercise test with sufficiently high and precisely standardized exercise load. Cold air inhalation together with exercise may also increase the sensitivity of the test. Following up the patient and assessing the effect of prescribed treatment is also part of the diagnostic process. Exercise tests may also be used to monitor the effect of asthma treatment. EIA is frequently seen in athletes, especially endurance athletes. Because there are reasons to believe that heavy training may increase airways inflammation and bronchial hyperresponsiveness, special considerations apply for treating EIA in athletes. Optimal treatment of asthma usually represents proper treatment of EIA. Inhaled steroids improve EIA. but additional treatment before exercise is often needed. Inhaled short- and long-acting beta(2)-agonists are often the treatment of choice, but chromones have also been used with good effect, and now leukotriene antagonists may prove to be a useful choice. The efficacy of the prescribed treatment for EIA should be controlled by follow-up consultations and the treatment modified if needed.