Approach to the diagnosis and management of suspected exercise-induced bronchoconstriction by primary care physicians
ABSTRACT Exercise-related respiratory symptoms in the diagnosis of exercise-induced bronchoconstriction (EIB) have poor predictive value. The aim of this study was to evaluate how athletes presenting with these symptoms are diagnosed and managed in primary care.
An electronic survey was distributed to a random selection of family practitioners in England. The survey was designed to assess the frequency with which family practitioners encounter adults with exercise-related respiratory symptoms and how they would approach diagnostic work-up and management. The survey also evaluated awareness of and access to diagnostic tests in this setting and general knowledge of prescribing asthma treatments to competitive athletes.
257 family practitioners completed the online survey. One-third of respondents indicated they encountered individuals with this problem at a frequency of more than one case per month. Over two-thirds of family practitioners chose investigation as an initial management strategy, while one-quarter would initiate treatment based on clinical information alone. PEFR pre- and post-exercise was the most commonly selected test for investigation (44%), followed by resting spirometry pre- and post-bronchodilator (35%). Short-acting beta2-agonists were the most frequently selected choice of treatment indicated by respondents (90%).
Family practitioners encounter individuals with exercise-related respiratory symptoms commonly and although objective testing is often employed in diagnostic work-up, the tests most frequently utilised are not the most accurate for diagnosis of EIB. This diagnostic approach may be dictated by the reported lack of access to more precise testing methods, or may reflect a lack of dissemination or awareness of current evidence. Overall the findings have implications both for the management and hence welfare of athletes presenting with this problem to family practitioners and also for the competitive athletes requiring therapeutic use exemption.
Full-textDOI: · Available from: Les Ansley, Jun 02, 2015
SourceAvailable from: Oliver J Price
Article: Asthma in Elite Athletes: Who Cares?[Show abstract] [Hide abstract]
ABSTRACT: Asthma or exercise-induced bronchoconstriction is highly prevalent in athletes and if untreated has the potential to impact on their health and performance. The condition can be diagnosed and managed effectively yet there is concern that the care afforded to elite athletes with this condition is often suboptimal. In this respect, it is apparent that more could be done to protect athletes from developing airway dysfunction (eg, by reducing exposure to irritant environments); that the diagnosis of asthma in athletes is often made without secure objective evidence and that athletes may be advised to reduce activity levels in order to improve symptoms. Moreover there appears to be poor surveillance of airway health in athletes when a diagnosis of asthma has been made. Overall this raises the question of who cares about athletes with asthma? The article that follows present the case of why this is an important clinical area for physicians. The review provides an overview of asthma in athletes with the overall aim of ensuring that respiratory health in this unique population is optimized.Clinical Pulmonary Medicine 03/2014; 21(2):68-75. DOI:10.1097/CPM.0000000000000030
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ABSTRACT: Exercise-induced bronchoconstriction (EIB) describes the post exercise phenomenon of acute airway narrowing in association with physical activity. A high prevalence of EIB is reported in both athletic and recreationally active populations. Without treatment, EIB has the potential to impact upon both health and performance. It is now acknowledged that clinical assessment alone is insufficient as a sole means of diagnosing airway dysfunction due to the poor predictive value of symptoms. Furthermore, a broad differential diagnosis has been established for EIB, prompting the requirement of objective evidence of airway narrowing to secure an accurate diagnosis. This article provides an appraisal of recent advances in available methodologies, with the principle aim of optimising diagnostic assessment, treatment and overall clinical care.Expert Review of Respiratory Medicine 02/2014; DOI:10.1586/17476348.2014.890517
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ABSTRACT: This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis of exercise-induced bronchoconstriction (EIB), a transient airway narrowing that occurs during and most often after exercise in people with and without underlying asthma. EIB is both commonly underdiagnosed and overdiagnosed. EIB underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Routine use of a reliable and valid self-administered EIB screening questionnaire by professionals best positioned to screen large numbers of people could substantially improve the detection of EIB. The authors conducted a systematic review of the literature that evaluated the accuracy of EIB screening questionnaires that might be adopted for widespread EIB screening in the general population. Results of this review indicated that no existing EIB screening questionnaire had adequate sensitivity and specificity for this purpose. The authors present a call to action to develop a new EIB screening questionnaire, and discuss the rigorous qualitative and quantitative research necessary to develop and validate such an instrument, including key methodological pitfalls that must be avoided.05/2014; 2(3):275-280.e7. DOI:10.1016/j.jaip.2013.11.001