From the Guidelines
Managing exercise-induced asthma requires a multifaceted approach, with the most effective strategy being the prophylactic use of short-acting bronchodilators, such as albuterol, 5-20 minutes before exercise, as recommended by the American Thoracic Society 1. This approach is based on a systematic review of the literature that identified eight randomized trials, of which five were pooled, showing that patients who received an inhaled SABA had a maximum percent fall in FEV1 after exercise that was 26.03% less than that among patients who received placebo. Key components of management include:
- Preventive measures: using a short-acting bronchodilator like albuterol (2 puffs, 15-30 minutes pre-exercise) to prevent symptoms, as supported by the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1
- Treatment strategies: daily controller medications such as inhaled corticosteroids (like fluticasone or budesonide) or leukotriene modifiers (montelukast) for those with frequent symptoms
- Warm-up and cool-down exercises: 10-15 minutes before intense activity and afterward to minimize exercise-induced bronchospasm
- Environmental considerations: exercising in warm, humid environments rather than cold, dry conditions, wearing a face mask or scarf in cold weather, and avoiding outdoor exercise on high-pollution or high-allergen days
- Symptom management: stopping activity, using a rescue inhaler, and resting until breathing normalizes if symptoms occur during exercise Regular physical activity has been shown to reduce the risk of asthma exacerbations in individuals with asthma, and exercise training can improve asthma symptoms, anxiety, depression, and quality of life in people with moderate to severe, persistent asthma 1.
From the FDA Drug Label
For patients 15 years of age and older for the prevention of exercise-induced asthma: Take SINGULAIR at least 2 hours before exercise. Always have your inhaled rescue medicine for asthma attacks with you. If you are taking SINGULAIR daily for chronic asthma or allergic rhinitis, do not take an additional dose to prevent exercise-induced asthma Speak to your doctor about your treatment of exercise-induced asthma. Do not take an additional dose of SINGULAIR within 24 hours of a previous dose.
To manage exercise-induced asthma, take SINGULAIR at least 2 hours before exercise. It is also important to always have your inhaled rescue medicine for asthma attacks with you. If you are already taking SINGULAIR daily for chronic asthma or allergic rhinitis, do not take an additional dose to prevent exercise-induced asthma. You should speak to your doctor about your treatment of exercise-induced asthma and not take an additional dose of SINGULAIR within 24 hours of a previous dose 2.
From the Research
Managing Exercise-Induced Asthma
To manage exercise-induced asthma, several strategies can be employed:
- Use of short-acting beta-agonists (SABAs) such as albuterol before exercise to provide symptom relief and protect against exercise-induced asthma 3, 4
- Use of long-acting beta-agonists (LABAs) such as salmeterol and formoterol, which provide more prolonged bronchodilation and can be used in combination with inhaled corticosteroids 3, 5
- Optimization of inhaled corticosteroid doses to ensure that anti-inflammatory therapy is maximized, allowing for intermittent use of beta2-agonists as prophylactic medication 6, 7
Treatment Options
Treatment options for exercise-induced asthma include:
- Inhaled beta2-agonists, which can be used as needed or before exercise to prevent symptoms 4
- Combination therapy with inhaled corticosteroids and LABAs, which can provide better control of asthma symptoms and reduce the need for rescue medication 3, 6
- Anti-inflammatory reliever (AIR) therapy, which combines an inhaled corticosteroid with a reliever medication such as albuterol or formoterol in a single inhaler 6
Considerations for Daily Use of Beta2-Agonists
Daily use of beta2-agonists can lead to: