Exercise-Induced Bronchoconstriction (EIB) in Athletes — Diagnosis, Pathophysiology, Prevention, and Implications for Training
DOI:
https://doi.org/10.12775/QS.2026.63.73050Keywords
exercise-induced bronchoconstriction, elite athletes, anti-doping regulations, differential diagnosis, sports medicineAbstract
Introduction. Competitive sports training places unprecedented demands on the respiratory system. Targeted pharmacotherapy and modifications to environmental conditions have proven to be highly effective tools for supporting respiratory reserve, leading to the protection of lung structure and an improvement in maximal oxygen uptake (VO2max). Nevertheless, serious concerns remain regarding common diagnostic errors and the risk of violating strict anti-doping regulations (WADA).
Research objective. This literature review synthesizes current knowledge on the pathophysiology, objective diagnosis, differential diagnosis, screening, treatment, and training implications of exercise-induced bronchoconstriction (EIB) in elite athletes, taking into account current anti-doping regulations.
Methodology. The review is based on a structured search of the PubMed database through May 2026. Keywords included: “exercise-induced bronchoconstriction”, “elite athletes”, “asthma in sports”, “exercise-induced laryngeal obstruction”, “airway remodeling”, and “WADA regulations”. Priority was given to clinical trials, systematic reviews, large observational studies, and international consensus documents regarding the management of respiratory system dysfunctions in sports. Articles were analyzed for their relevance to describing pathophysiological mechanisms, objective diagnostic algorithms, differential diagnosis, and pharmacotherapy compliant with anti-doping regulations.
Conclusions. Objective diagnostics and targeted anti-inflammatory treatment represent significant progress in the care of elite athletes with EIB, ensuring the preservation of aerobic capacity and lung health; however, their implementation requires careful monitoring of drug dosage limits and avoidance of tachyphylaxis. The use of provocation tests is essential to optimize therapy, rule out other upper respiratory tract pathologies, and ensure safe, level competition.
References
Ora, J., et al. "Exercise-Induced Asthma: Managing Respiratory Issues in Athletes." Journal of Functional Morphology and Kinesiology, vol. 9, 2024. https://doi.org/10.3390/jfmk9010015
Goossens, J., et al. "Activation of epithelial and inflammatory pathways in adolescent elite athletes exposed to intense exercise and air pollution." Thorax, vol. 78, 2023, pp. 775 - 783. https://doi.org/10.1136/thorax-2022-219651
Klain, A., et al. "Exercise-induced bronchoconstriction, allergy and sports in children." Italian Journal of Pediatrics, vol. 50, 2024. https://doi.org/10.1186/s13052-024-01594-0
Goossens, J., et al. "Exercise‐induced bronchoconstriction in adolescent recreational athletes: Potential screening strategies." Pediatric Allergy and Immunology, vol. 35, 2024. https://doi.org/10.1111/pai.14220
Hostrup, M., et al. "Asthma and exercise‐induced bronchoconstriction in athletes: Diagnosis, treatment, and anti‐doping challenges." Scandinavian Journal of Medicine & Science in Sports, vol. 34, 2023. https://doi.org/10.1111/sms.14358
Cao, Zhi, et al. "Prevalence of exercise-induced bronchoconstriction in elite Chinese summer sport athletes.." Journal of sport and health science, 2026, pp. 101131. https://doi.org/10.1016/j.jshs.2026.101131.
Aggarwal, B., et al. "Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management." NPJ Primary Care Respiratory Medicine, vol. 28, 2018. https://doi.org/10.1038/s41533-018-0098-2
Dickinson, John, et al. "Do Patients With Physician Diagnosis Of Exercise-induced Bronchoconstriction Provide A Positive Eucapnic Voluntary Hyperpnoea Challenge?." Medicine & Science in Sports & Exercise, 2023. https://doi.org/10.1249/01.mss.0000983432.73088.ef
Da Silva, Ronaldo Aparecido, et al. "Effect of Pharmacological Treatment on Exercise-Induced Bronchoconstriction and Allergic Inflammatory Response in Endurance Athletes." International Journal of Sports Physical Therapy, vol. 20, 2025, pp. 1222 - 1231. https://doi.org/10.26603/001c.141859.
Jackson, A., et al. "Impact of detecting and treating exercise-induced bronchoconstriction in elite footballers." ERJ Open Research, vol. 4, 2018. https://doi.org/10.1183/23120541.00122-2017.
Brukner, P., et al. "The Impact of Exercise-induced Bronchoconstriction on Exercise Performance: 639." Medicine and Science in Sports and Exercise, vol. 39, 2007. https://doi.org/10.1249/01.mss.0000272998.16528.d8.
Pigakis, Konstantinos M, et al. "Impact of Isolated Exercise-Induced Small Airway Dysfunction on Exercise Performance in Professional Male Cyclists." Sports, vol. 12, 2024. https://doi.org/10.3390/sports12040112.
Grandinetti, R., et al. "Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment." Journal of Clinical Medicine, vol. 13, 2024. https://doi.org/10.3390/jcm13154558
Koya, T., et al. "Management of Exercise-Induced Bronchoconstriction in Athletes.." The journal of allergy and clinical immunology. In practice, vol. 8 7, 2020, pp. 2183-2192. https://doi.org/10.1016/j.jaip.2020.03.011.
Ameri, Sammy, et al. "Mechanisms and Biomarkers of Exercise-induced Bronchoconstriction: Current Insights and Future Directions.." Immunology and allergy clinics of North America, vol. 45 1, 2024, pp. 63-75. https://doi.org/10.1016/j.iac.2024.08.009
Klain, A., et al. "Exercise-Induced Bronchoconstriction in Children." Frontiers in Medicine, vol. 8, 2022. https://doi.org/10.3389/fmed.2021.814976
Szczap, Izabela, et al. "EXERCISE-INDUCED BRONCHOCONSTRICTION: PATHOGENESIS, SYMPTOMS, DIAGNOSIS AND CURRENT TREATMENT - LITERATURE REVIEW." International Journal of Innovative Technologies in Social Science, 2025. https://doi.org/10.31435/ijitss.3(47).2025.3899
Murphy, R. C., et al. "Distinct Epithelial-Innate Immune Cell Transcriptional Circuits Underlie Airway Hyperresponsiveness in Asthma.." American journal of respiratory and critical care medicine, 2023. https://doi.org/10.1164/ajrccm-conference.2023.207.1_meetingabstracts.a2765
Anderson, Sandra D., and P. Kippelen. "A proposal to account for the stimulus, the mechanism, and the mediators released in exercise-induced bronchoconstriction." Frontiers in Allergy, vol. 4, 2023. https://doi.org/10.3389/falgy.2023.1004170
Černohorská, Alicja, et al. "Exercise Induced Bronchoconstriction - An Overview." Quality in Sport, 2025. https://doi.org/10.12775/qs.2025.38.58304.
Fainardi, Valentina, et al. "Exercise-induced bronchoconstriction in children: Delphi study and consensus document about definition and epidemiology, diagnostic work-up, treatment, and follow-up." Respiratory Research, vol. 25, 2024. https://doi.org/10.1186/s12931-024-03078-5
Ersson, K., et al. "Prevalence of exercise‐induced bronchoconstriction and laryngeal obstruction in adolescent athletes." Pediatric Pulmonology, vol. 55, 2020, pp. 3509 - 3516. https://doi.org/10.1002/ppul.25104
Atchley, T., and Derek M. Smith. "Exercise-induced Bronchoconstriction in Elite or Endurance Athletes: Pathogenesis and Diagnostic Considerations.." Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2020. https://doi.org/10.1016/j.anai.2020.01.023
Reier-Nilsen, Tonje, et al. "Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes." BMJ Open Sport & Exercise Medicine, vol. 9, 2023. https://doi.org/10.1136/bmjsem-2023-001680
Dickinson, J., et al. "Diagnosis of exercise-induced bronchoconstriction: eucapnic voluntary hyperpnoea challenges identify previously undiagnosed elite athletes with exercise-induced bronchoconstriction." British Journal of Sports Medicine, vol. 45, 2010, pp. 1126 - 1131. https://doi.org/10.1136/bjsm.2010.072520
Hull, J., et al. "Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes?." Sports Medicine (Auckland, N.z.), vol. 46, 2016, pp. 1083 - 1093. https://doi.org/10.1007/s40279-016-0491-3
Price, O., et al. "Diagnosing exercise-induced bronchoconstriction with eucapnic voluntary hyperpnea: is one test enough?." The journal of allergy and clinical immunology. In practice, vol. 3 2, 2015, pp. 243-9. https://doi.org/10.1016/j.jaip.2014.10.012
Jackson, A., et al. "Diagnosing Exercise Induced Bronchoconstriction: A comparison of Eucapnic Voluntary Hyperpnoea and Exercise in low humidity." Medicine & Science in Sports & Exercise, 2017. https://doi.org/10.1249/01.mss.0000516858.73470.87
Reier-Nilsen, T., et al. "An app-based spirometer for home use can detect exercise-induced bronchoconstriction in athletes." 01.05 - Clinical respiratory physiology, exercise and functional imaging, 2022. https://doi.org/10.1183/13993003.congress-2022.1087
Hanks, C., et al. "Etiology of Dyspnea in Elite and Recreational Athletes." The Physician and Sportsmedicine, vol. 40, 2012, pp. 28 - 33. https://doi.org/10.3810/psm.2012.05.1962
Griffin, S., et al. "Breathless athlete: exercise-induced laryngeal obstruction." British Journal of Sports Medicine, vol. 52, 2018, pp. 1211 - 1212. https://doi.org/10.1136/bjsports-2018-099159
Hammer, Jansrud I., et al. "Conundrums in the breathless athlete; exercise‐induced laryngeal obstruction or asthma?." Scandinavian Journal of Medicine & Science in Sports, vol. 32, 2022, pp. 1041 - 1049. https://doi.org/10.1111/sms.14137
Clemm, H., et al. "Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on ‘acute respiratory illness in the athlete’." British Journal of Sports Medicine, vol. 56, 2022, pp. 622 - 629. https://doi.org/10.1136/bjsports-2021-104704
Rundell, K., and Pnina Weiss. "Exercise-Induced Bronchoconstriction and Vocal Cord Dysfunction: Two Sides of the Same Coin?." Current Sports Medicine Reports, vol. 12, 2013, pp. 45–50. https://doi.org/10.1249/jsr.0b013e318281e471
Turmel, J., et al. "Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction." BMJ Open Sport — Exercise Medicine, vol. 1, 2015. https://doi.org/10.1136/bmjsem-2015-000065
Dreßler, M., et al. "Are Questionnaires Helpful To Predict Exercise-Induced Bronchoconstriction (EIB) And Exercise-Induced Laryngeal Obstruction (EILO)?." Klinische Pädiatrie, 2024. https://doi.org/10.1055/a-2151-2269
Penelitian, J., et al. "Managing Exercise-Induced Bronchoconstriction: A Comprehensive Review of Strategies for Athletes to Maintain Fitness and Health." Jurnal Penelitian Pendidikan IPA, 2024. https://doi.org/10.29303/jppipa.v10ispecialissue.8659.
Calzetta, L., et al. "Pharmacological Advances in Managing Exercise‐Induced Bronchospasm: An Umbrella Review Following PRIOR Guideline." Scandinavian Journal of Medicine & Science in Sports, vol. 36, 2026. https://doi.org/10.1111/sms.70196.
Cao, Zhi, et al. "The impact of tangeretin combined with whey protein on exercise-induced bronchoconstriction in professional athletes: a placebo-controlled trial." Journal of the International Society of Sports Nutrition, vol. 21, 2024. https://doi.org/10.1080/15502783.2024.2414870.
Venckūnas, T., and Domantas Balsys. "Pulmonary function as a limiting factor of middle distance race performance.." The Journal of sports medicine and physical fitness, 2021. https://doi.org/10.23736/s0022-4707.21.12042-0.
Venckūnas, T., and Domantas Balsys. "High Incidence of Bronchospastic Response to a Stair Climbing Exercise." Cureus, vol. 13, 2021. https://doi.org/10.7759/cureus.14843.
Malewska-Kaczmarek, Kamila, et al. "Exercise-Induced Bronchoconstriction in Children: A Comparison between Athletes and Non-Athletes." Healthcare, vol. 11, 2023. https://doi.org/10.3390/healthcare11091349.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Igor Mszyca, Emilia Browarska, Oskar Pastuszek, Katarzyna Miemczyk, Filip Tadeusz Wołek, Łukasz Michalski, Nicole Gajewska , Karolina Natalia Mularczyk, Kacper Kucharski, Anna Aksamit, Katarzyna Superson
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 128
Number of citations: 0
