Exercise-induced asthma--clinical, physiological, and therapeutic implications

Exercise provokes acute airways obstruction, maximum shortly after stopping, in virtually all asthmatic patients. The severity of this exercise-induced asthma (EIA) depends upon the type of exercise, with running being the most asthmogenic, swimming and walking the least, and cycling intermediate even with the same metabolic stress. The duration and severity of the exercise also affect the amount of EIA, the maximum amount of being obtained after 6 to 8 min of running hard enough to raise the heart rate to 180 beats per minute (bpm) in children or 140 bpm in adults. EIA is not the result of hyperventilation or blood gas changes and appears to depend on the release of relatively short-lived transmitter agents during the exercise period. EIA can be prevented by premedication with bronchodilators, especially with sympathomimetics. Cromolyn sodium is not a bronchodilator but inhibits EIA in most subjects if given before the exercise. EIA can also be inhibited by atropine and alpha adrenergic blockers in some patients, but by steroids in only a minority of cases. Exercise testing provides a good model for study of the physiology and pharmacology of clinical asthma, and is some guide to prognosis, but it must be properly standardized and the important differences must be appreciated.