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Asthma - Management
Exercise-induced asthma: How do I manage?

  • If exercise-induced asthma is a symptom of poor asthma control, manage it as uncontrolled asthma.
  • If a person has otherwise well-controlled asthma, but finds exercise-induced asthma to be a problem:
    • Advise short-burst activities, exercising in humid environments, and breathing through the nose to avoid hyperventilation.
    • Prescribe use of a short-acting beta2-agonist 10–15 minutes before the start of exercise and after 2 hours of prolonged exercise, or after exercise has finished.
  • If exercise-induced symptoms persist despite use of a short-acting beta2-agonist (adequate dosage with good concordance):
  • If the person does not respond to treatment and exercise-induced asthma is still problematic (especially in athletes), consider referral to a respiratory specialist.
Clarification / Additional information
  • Confirming the diagnosis of exercise-induced asthma can be difficult:
    • Ask about a cough (usually starting 6–10 minutes after the start of exercise) and associated chest tightness (up to 1–2 hours afterwards). Some people may have symptoms starting after exercise.
    • Ask about other symptoms not related to exercise, such as nocturnal cough, wheeze, or breathlessness, that might indicate poorly controlled asthma.
    • Give the person a peak flow diary and ask them to measure their peak flow before and 5 minutes after exercise to help support the diagnosis.
Basis for recommendation
  • These recommendations are based on the British Guideline on the Management of Asthma: a national clinical guideline [SIGN and BTS, 2009]:
    • Very little evidence supports the use of any medication in exercise-induced asthma in children younger than 5 years. Most of the evidence is from poor-quality trials involving small numbers of people with or without poorly controlled asthma and using different doses of medication over different durations.
    • Exercise-induced asthma is often an indication of poorly controlled asthma. If control of asthma is improved, the symptoms of exercise-induced asthma will usually cease.
    • Inhaled short-acting beta2-agonists are the most effective therapy for prevention of exercise-induced asthma. Regular use offers no advantage over as-required regimens and may result in tolerance [SIGN and BTS, 2009].
    • Long-acting beta2-agonists, leukotriene receptor antagonists, and cromones are more effective than placebo in controlling exercise-induced asthma in small randomized controlled trials, but they are no more effective than short-acting beta2-agonists [SIGN and BTS, 2009].

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