Pharmacological Methods of EIB Treatment
The ATS guidelines for the general population with EIB showed that EIB
can be present both in patients with and without confirmed asthma. They
recommend taking a short-acting β2-agonist (SABA) inhalation 5-20
minutes prior to a planned exercise. When SABA dosing is more frequent
but the patient still suffers from EIB symptoms, daily monotherapy with
inhaled corticosteroids (ICS) is recommended, which are considered the
most effective anti-inflammatory agents in EIB treatment. A long-acting
β2-agonist (LABA) may be used if necessary. Among the drugs with
protective effects against EIB, formoterol (LABA) in dry powder
inhalation can prevent EIB within a few minutes after administration for
a duration of at least 4 hours37. Among athletes who
rarely experience EIB episodes, it is sufficient to administer SABA
before exercise.
Daily use of a leukotriene receptor antagonist (LTRA) is also
recommended. It should be taken about two hours before planned exercise,
however its effects are smaller than in the case of SABA or ICS. As a
second-line therapy, it is possible to use inhaled anticholinergic
agents or a mast cell stabilizing agent before exercise. Among patients
suffering from EIB and allergies, who use SABA only before exercise or
in patients with daily and more frequent use of SABA – addition an
antihistamine is recommended.
Ducharme F. emphasizes that for adults with a mild or moderate asthma it
has been demonstrated that equivalent to 400 g / day beclomethasone is
more effective than leukotriene receptor antagonists. The authors
suggest that among treated children there is insufficient evidence to
detect the efficacy of leukotriene antagonists, but others argue that
anti-leukotriene drugs should remain a treatment option for the athletes
with EIB when SABA and ICS therapy is insufficient38.