Exercise-induced bronchoconstriction

Exercise-induced bronchoconstriction Do not use montelukast as monotherapy. Patients should continue to use their usual regimen of inhaled beta-agonists as prophylaxis and have a short-acting inhaled beta-agonist available for rescue. 

A Cochrane Review of 20 randomised controlled trials involving 280 participants, showed that 4 mg, of nedocromil sodium inhaled 15-60 minutes prior to exercise significantly reduces the severity and duration of exercise-induced bronchus constriction in both adults and children, when compared to placebo. This effect appears to be more pronounced in people with severe exercise-induced bronchoconstriction. 

Parsons JP, MastronardeJG. Exercise-induced bronchoconstriction in athletes. Chest. 2005 128 3966-3974. 

Spooner CH, Saunders LD, Rowe BH. Nedocromil sodium for preventing exercise-induced bronchoconstriction. Cochrane Database Syst Rev. 2002 CD001183. 

Hawksworth RJ, Sykes AP, Faris M, Mant T, Lee TH. Albuterol HFA is as effective as albuterol CFC in preventing exercise-induced bronchoconstriction. Ann Allergy Asthma Immunol 2002 88(5) 473-7. 

Fisher DA. Exercise-induced bronchoconstriction related to isotretinoin therapy. J Am Acad Dermatol 1985 13(3) 524. 

Inman MD, O Byrne PM. The effect of regular inhaled albuterol on exercise-induced bronchoconstriction. Am J Respir Crit Care Med 1996 153 65-69. 

Mickleborough, T.D., Murray, R.L., lonescu, A.A., and Lindley, M.R., Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes, Am. J. Respir. Crit. Care Med., 168, 1181-1189, 2003. 

Mickleborough, T.D. and Rundell, K.W., Dietary polyunsaturated fatty acids in asthma- and exercise-induced bronchoconstriction, Eur. J. Clin. Nutr., 59,1335-1346, 2005. 

Ipratropium bromide and tiotropium bromide are competitive inhibitors of muscarinic receptors they produce bronchodilation only in cholinergic-mediated bronchoconstriction. Anticholinergics are effective bronchodila-tors but are not as potent as /J2-agonists. They attenuate, but do not block, allergen- or exercise-induced asthma in a dose-dependent fashion. 

Sheppard, D., A.Saisho, J.A.Nadel, and H.A.Boushey. 1981. Exercise increases sulfur dioxide-induced bronchoconstriction in asthmatic subjects. Am. Rev. Respir. Dis. 123(5) 486-491. Skalpe, I.O. 1964. Long-term effects of sulphur dioxide exposure in pulp mills. Br. Ind. Med. 21 69— 73. 

Aerosolized SKF 104353,100 and 800 /Ltg, shifted LTD4-induced bronchoconstriction by about 10-fold in normal and asthmatic individuals, respectively, when administered 2-3.5 h before challenge (242). The same dose protected against exercise-induced asthma (243). SKF 106203 was examined in normal volunteers and a 200 mg p.o. dose was effective in reducing LTD4-induced bronchoconstriction, with the maximal effect being observed 8 h after dosing (244). 

Beta2 selective drugs (albuterol, metaproterenol, terbutaline) are widely used for relief of acute bronchoconstriction and in prophylaxis of exercise-induced asthma (see Figure VI-1-4). 

Exercise-Induced Asthma. In some asthmatics (usually young, allergic patients) moderate to severe exercise can initiate an asthmatic attack. As with intrinsic asthma, the etiology of exercise-induced asthma has not been well defined. One theory (Deal et al, 1979) suggests that cold-sensitive irritant receptors in the epithelia are associated with afierent nerve fibers within an autonomic reflex arc. Efferent motor fibers of this reflex then return to the airway smooth muscle via the vagus nerve. Thus, bronchoconstriction is induced through this reflex arc by stimulation of the cold-sensitive irritant receptors. 

Pj-selective agonists are used for the relief of acute bronchoconstriction and as a prophylaxis in exercise-induced asthma. Longer-acting p-adrenoceptor agonists can be used prophylactically to decrease nighttime attacks. The mechanisms responsible for their effects are shown in Figure Vl-8-1, which illustrates the action of antiasthmatic drugs. 

Ahmed T, Garrigo J, Danta I. Preventing bronchoconstriction in exercise-induced asthma with inhaled heparin. N Engl J Med 1993 329 90-95. 

Median durations with the highest value after a single dose and lowest after chronic administration. cProtedion refers to the prevention of bronchoconstriction induced by exercise or nonspecific bronchial challenges. 

Protection refers to the prevention of bronchoconstriction induced by exercise or nonspecific bronchial challenges. 

Russell, J. A, and Lai-Fook, S. J., 1979, Reflex bronchoconstriction induced by capsaicin in the dog,/. Appl. Physiol. Respir. Environ. Exercise Physiol. 47 961-967. 

---