V.PRAVIN RAJ, MPT, SPORTS PHYSIOTHERAPY, ANNAMALAI UNIVERSITY

1. EXERCISE INDUCED
BRONCHIAL OBSTRUCTION
Pravinraj v MPT
Sports physiotherapy

2. “Defined as the transient narrowing
of the lower airways following
vigorous exercise, is common
among adolescents”.
-EIB affects up to 90% of those with asthma.
-EIB affects up to 35% of those without known
asthma.

3. Epidemiology
 Higher prevalence in elite athlete than in
normal. -depend on sport and environment.
 Adult and children (10-20%)
 Gender and race
Some studies: female > male.
African, American and Asian.
 Season: winter > summer.

4. Factors contributing to the severity of EIB
include ambient air conditions.
Eg.,
cold air.
low humidity.
Pollution.
Respiratory tract infection(viral infection).

6. Signs and symptoms
• EIB occurs in three distinct phase, symptoms peak 5 to 10 minutes
after exercise begins, and they last for 30 to 60 minutes.
• Common signs and symptoms are,
 chest pain
 chest tightness
 burning sensation
 with or without wheezing
 dry cough
 shortness of breath after or during exercise
 excess mucus

7. EIB symptoms typically appear after 8 to 10 minutes of
vigorous exercise and may Worsen after activity is terminated.
Approximately 50% of individuals with EIB experience the
second phase.
This phase starts 30 minutes to 4 hours after exercise begins
and is associated with Limited to no bronchosapsm.
The final phase involves symptoms similar to those
experienced during the first Phase, but these symptoms are less
severe.
Symptoms recur 12 to 16 hours after exercise is completed
and usually remit 24 hours.

8. management
Pharmacological treatments
• Inhale corticosteroid
• Short acting bronchodilators
• Cromolyn sodium
• Nedocromil sodium
 therapies given before exercise
 competitive athletes, should consult with the
appropriate governing sport body to ensure the
medication is legal for competition.

9. Nonpharmacological therapies
Pre exercise: warm up 60-80% HR max × 10-15 mins
-Given bronchoprotective effect and extended
refractory period from 1-4 hr.
-recommend add on parmacotherapy better than warm
up alone or SABA alone.
Post exercise: warm down × 10-15 mins.
Nasal breathing.
Wearing a mask in cold environments.
Avoid exercise in conditions where air is cold and dry.
Low salt diet.

10. General recommendations
• Consult a physician before beginning an exercise
program.
• Take medication for asthma as prescribed to achieve
overall control as asthmatic symptoms.
• Use a peak flowmeter as directed by physician.
• Avoid exposure to air pollutants and allergens
whenever possible.
• Avoid exercise during the early morning hours, when
the concentration of ragweed is highest.