An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction

Am J Respir Crit Care Med. 2013 May 1;187(9):1016-27. doi: 10.1164/rccm.201303-0437ST.


Background: Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma.

Methods: To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

Results: Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting β(2)-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β(2)-agonist before exercise, strong recommendations were made for a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise.

Conclusions: The recommendations in this Guideline reflect the currently available evidence. New clinical research data will necessitate a revision and update in the future.

Publication types

  • Practice Guideline

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-Agonists / therapeutic use*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma, Exercise-Induced* / diagnosis
  • Asthma, Exercise-Induced* / drug therapy
  • Asthma, Exercise-Induced* / prevention & control
  • Evidence-Based Medicine
  • Humans
  • Leukotriene Antagonists / therapeutic use*


  • Adrenergic beta-Agonists
  • Anti-Asthmatic Agents
  • Leukotriene Antagonists