Asthma Management Handbook
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Table. Managing persistent exercise-induced respiratory symptoms in adults and adolescents

Clinical scenario

Action

Notes

Prior confirmed asthma diagnosis and recent asthma symptom control is assessed as partial or poor*

Start low-dose ICS (if not already using a preventer) or step up preventer regimen#

Salbutamol 15 minutes before exercise§

Review in 4–12 weeks

 

Prior confirmed asthma diagnosis, recent asthma symptom control is assessed as partial or good,* and symptoms only occur with exercise

Exercise symptoms on most or all days

Start low-dose ICS (if not already using a preventer) or step up preventer regimen# and review in 4–12 weeks

Consider alternative causes (e.g. poor cardiopulmonary fitness, upper airway dysfunction)

EIB can occur despite otherwise well-controlled asthma

 

Exercise symptoms some days

Salbutamol 15 minutes before exercise§

Continue preventer if used

No previous diagnosis of asthma

Investigate as for asthma (history, physical examination and spirometry before and after bronchodilator)**

If asthma confirmed, follow management recommendations

If asthma not confirmed by spirometry, consider:

  • a trial of salbutamol 15 minutes before exercise§
  • whether regular preventer treatment is indicated
  • indirect challenge testing

Review in 4–12 weeks

For adolescents, consider early referral to an accredited respiratory function laboratory for indirect challenge testing or respiratory physician for investigation to rule out other common causes of exercise-related respiratory symptoms

Competing athletes

Consider indirect challenge testing. (Check which tests are required to demonstrate airway hyperresponsiveness)

Check which medicines are permitted in the particular sport by consulting ASADA (www.asada.gov.au) before prescribing any medicine

Advise warm-up before planned exercise

* See Table. Definition of levels of recent asthma symptom control in adults and adolescents (regardless of current treatment regimen)

# Before stepping up, check that inhaler technique is correct and adherence is adequate. See Figure. Stepped approach to adjusting asthma medication in adults

† If exercise-induced symptoms do not resolve after adjusting medicines, and checking adherence and inhaler technique, consider alternative diagnoses, referral to an accredited respiratory function laboratory for indirect challenge testing, or referral to a respiratory physician for assessment.

§ Reliever should also be taken at other times as needed to manage symptoms

** See Figure. Steps in the diagnosis of asthma in adults

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