Exercise-Induced Bronchoconstriction in Athletes: Pathophysiology, Diagnosis and Management - a literature review

Abstract

Introduction

Exercise-induced bronchoconstriction (EIB) is a transient lower airway narrowing occurring during or post-vigorous physical activity. Unlike exercise-induced asthma (EIA), characterized by chronic inflammation, EIB affects both asthmatic and non-asthmatic individuals. It is the primary chronic condition in elite athletes, with prevalence reaching 70% in endurance disciplines. Untreated EIB impairs respiratory health, mental well-being, and sports performance.

Materials and Methods

A systematic literature search was conducted, based on the following databases: Embase, PubMed, Cochrane Library, and Google Scholar, in reference to PRISMA guidelines. The keyword choice was decided beforehand in relation to the subject of the review.

The Stage of Knowledge

EIB pathophysiology centers on the hyperosmolar theory. Intense hyperventilation causes evaporative water loss and airway cooling. This osmotic shift and rapid rewarming trigger mast cell degranulation, releasing inflammatory mediators like cysteinyl leukotrienes (CysLTs) that cause smooth muscle contraction. Environmental factors heavily exacerbate this: cold air, low humidity, pollution, toxins, causing the disruption of epithelial barriers

Summary

EIB is a major health burden for athletes. Accurate diagnosis is vital to differentiate isolated EIB from chronic asthma. Effective management uses pharmacological treatments, like CysLT receptor antagonists, alongside dietary interventions, including Vitamin C, Omega-3, and gut microbiota modulation. These interventions mitigate inflammation, prevent irreversible remodeling, and optimize athletic performance.