Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes

J Allergy Clin Immunol. 2008 Aug;122(2):238-46; quiz 247-8. doi: 10.1016/j.jaci.2008.06.014.


The prevalence of exercise-induced bronchoconstriction is reported to be high among recreational and elite athletes, yet diagnosis is often symptom-based. Indirect challenges such as the laboratory exercise challenge provide objective criteria for proper diagnosis and treatment. However, a standardized protocol using appropriate exercise intensity, duration, and dry air inhalation is often not implemented, and thus a false-negative test may result. This article reviews and describes the symptom-based diagnosis, the exercise challenge, and other indirect challenges such as eucapnic voluntary hyperpnea, hypertonic saline inhalation, and inhaled powdered mannitol as methods to diagnose and evaluate exercise-induced bronchoconstriction. Advantages and disadvantages of each diagnostic procedure are presented.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adenosine Monophosphate
  • Asthma, Exercise-Induced / diagnosis*
  • Bronchial Hyperreactivity / diagnosis*
  • Bronchoconstriction*
  • Exercise Test
  • Exercise*
  • Humans
  • Mannitol
  • Spirometry
  • Sports*


  • Mannitol
  • Adenosine Monophosphate