Practice parameterPathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter
Section snippets
Table of Contents
I. Classification of Recommendations and Evidence.....S3
II. Glossary..........................................S4
III. Preface..........................................S4
IV. Algorithm.........................................S5
V. Executive Summary..................................S6
VI. Summary Statements.................................S11
VII. Pathophysiology of Exercise-Induced Bronchoconstriction............S13
VIII. Prevalence......................................S17
IX.
Acknowledgments
The Joint Task Force acknowledges the following individuals who also contributed substantially to the creation of this parameter: Erin Shae Johns, PhD, and Jessica Karle, MS, for their immense help with formatting and restructuring this document, and Susan Grupe for providing key administrative help to the contributors and reviewers of this parameter. The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded
Category of evidence
- Ia
Evidence from meta-analysis of randomized controlled trials
- Ib
Evidence from at least 1 randomized controlled trial
- IIa
Evidence from at least 1 controlled study without randomization
- IIb
Evidence from at least 1 other type of quasi-experimental study
- III
Evidence from nonexperimental descriptive studies, such as comparative studies
- IV
Evidence from expert committee reports or opinions or clinical experience of respected authorities or both
Strength of recommendation
- A
Directly based on category I evidence
- B
Directly based on category II evidence or
Glossary
Exercise-induced bronchoconstriction (EIB) is defined as a transient narrowing of the lower airway following exercise in the presence or absence of clinically recognized asthma. The term exercise-induced asthma (EIA) is not used in this document because it may imply incorrectly that exercise causes rather than exacerbates or triggers an attack of asthma.
Bronchial hyperresponsiveness (BHR) is an increase in sensitivity to an agent and is expressed as the dose or concentration of a substance that
Preface
The goal of “Pathogenesis, Prevalence, Diagnosis, and Management of Exercise-Induced Bronchoconstriction: A Practice Parameter” is to empower health care specialty practitioners to provide outstanding health care services to their patients in diagnosing and managing EIB. This practice parameter is designed to accomplish this goal by providing the most up-to-date, evidence-based information and recommendations on the diagnosis and management of EIB. The term EIA is not used in this document
1
History, physical examination, and pulmonary function tests pre and postbronchodilator (with flow volume loops, and pre/postbronchodilator functions) are necessary if there is suspicion of asthma or EIB. History alone should not be used to diagnose or exclude the diagnosis of EIB. If pulmonary function equipment (i.e., spirometry) is not available in the clinic setting, patients should be referred to a pulmonary function laboratory or to a physician with office spirometry equipment. Peak flow
Introduction and Definition (Summary Statement 1)
Exercise-induced bronchoconstriction is defined as the transient narrowing of the lower airways that occurs after vigorous exercise.1, 2, 3, 4 Exercise-induced bronchoconstriction may be observed in patients who have or do not have chronic asthma based on spirometry.1, 2, 3, 4, 5, 6, 7, 8 The term EIA should no longer be used because exercise does not induce asthma but rather is a trigger of bronchoconstriction. The diagnosis of EIB usually requires a decrease in FEV1 after exercise of 10% to
Summary Statement 1
Exercise-induced bronchoconstriction is defined as the transient narrowing of the lower airways that occurs after vigorous exercise. It may appear with or without asthma. The term EIA should not be used because exercise does not induce asthma but rather is a trigger of bronchoconstriction. D
Summary Statement 2
Exercise-induced bronchoconstriction occurs in response to heating and humidifying large volumes of air during a short period. The most important determinants of expression of EIB response and severity are
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2024, Italian Journal of Pediatrics
These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “Pathogenesis, Prevalence, Diagnosis, and Management of Exercise-Induced Bronchoconstriction: A Practice Parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Reprint requests: Joint Task Force on Practice Parameters; 50 N. Brockway St., #3-3; Palatine, IL 60067.
Disclosures: Dr Weiler is an employee of CompleWare Corporation. He also holds stock in CompleWare Corporation and Iowa Clinical Research Corporation, neither of which is an ACCME defined Commercial Interest, and he sold shares of Johnson & Johnson. CompleWare Corporation and Iowa Clinical Research Corporation provided contracted or granted services to MedImmune, Sandoz, GlaxoSmithKline, NIH, ALK, Pharmaxis, Novartis, Abbott, TEVA, Boehringer Ingelheim, Schering-Plough/Merck, Forest, Roxane Labs, Amgen, Repros, and Watson. Dr Anderson is the inventor of the mannitol test and receives a percentage of the royalties paid to her employer, Sydney South West Area Health Service. Dr Randolph has been a member of the speakers' bureau for Alcon, ISTA, GlaxoSmithKline, AstraZeneca, ScheringPlough/Merck, UCB, Wallace, Dey, Sciele, Baxter, Accredo, Critical Care, Genentech/Novartis, Sepracor, Meda, Sanofi-Aventis, TEVA, Pfizer, and Verus. He has acted as an advisor or consultant to AstraZeneca, Merck, GlaxoSmithKline, and Sanofi-Aventis and provided granted services to ScheringPlough and Novartis/Genentech. Dr Bonini is a member of the expert forums and/or a speaker at sponsored symposia for ALK, Allergen Manufacturers, AstraZeneca, Chiesi, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novartis, Nycomed, Phadia, Schering-Plough, Sigma-Tau, Scalargenes, and UCB. Dr. Pearlman acts as an ad hoc consultant to AstraZeneca. He has also performed contract pharmaceutical research on EIB as a principal investigator between Colorado Allergy and Asthma Centers, P.C. (which pays him a salary) and each of the following companies: Merck, Novartis, Sepracor, GSK. Dr. Pearlman is also on the speakers' bureau of Merck. Dr Storms has provided granted services to Alcon Labs, Amgen, and Sepracor. He has acted as an advisor or consultant to Alcon Labs, AstraZeneca, Consumer Reports/Consumers Union, Merck, Nexcura, Novartis, Sepracor, Strategic Pharmaceutical Advisors, TEVA, and the TREAT Foundation. He also serves on the speakers' bureau for Alcon Labs, AstraZeneca, Meda, Merck, Novartis, Sepracor, Strategic Pharmaceutical Advisors, and the TREAT Foundation. Dr. Rundell is currently employed by Pharmaxis Inc. Dr. Oppenheimer has performed research, acted as a consultant, or served on the speakers' bureau for AstraZeneca, Merck, GlaxoSmithKline, Alcon Labs, and Novartis. Drs Craig, Silvers, Bernstein, Blessing-Moore, Cox, Khan, Lang, Nicklas, Portnoy, Schuller, Spector, Tilles, and Wallace have nothing to disclose.
Requests for reprints should be addressed to: Joint Council of Allergy, Asthma & Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067