From the Guidelines
The first-line treatment for exercise-induced bronchospasm using an inhaler is a short-acting beta-2 agonist (SABA) such as albuterol, taken 5-20 minutes before exercise. This recommendation 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 1. The typical dose is 2 puffs (90 mcg per puff) via metered-dose inhaler with proper technique.
Key Points to Consider
- Albuterol works by relaxing the smooth muscles in the airways, preventing the narrowing that occurs during exercise-induced bronchospasm.
- The medication binds to beta-2 receptors in the bronchial smooth muscle, activating adenyl cyclase and increasing cyclic AMP, which leads to bronchodilation.
- For optimal effectiveness, proper inhaler technique is essential: shake the inhaler, exhale completely, place the mouthpiece between lips forming a seal, inhale slowly while activating the inhaler, hold breath for 10 seconds, then wait 30-60 seconds before the second puff.
- If symptoms occur despite pre-treatment, the same medication can be used for rescue.
- For patients with frequent symptoms or those also diagnosed with asthma, a healthcare provider might recommend additional controller medications, as frequent or severe EIB may indicate the need to initiate or step up long-term control medications 1.
Additional Considerations
- Daily use of b2-agonists alone or in combination with ICSs may lead to tolerance, manifested as a reduction in duration of protection against EIB, and a prolongation of recovery in response to SABA after exercise 1.
- Other options like leukotriene receptor antagonists can attenuate EIB in as many as 50% of patients, but their onset of action is generally hours after administration 1.
- It's crucial to follow the recommended dosage and administration guidelines for SABAs, as outlined in the evidence 1, to ensure safety and efficacy.
From the FDA Drug Label
Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The first-line treatment for exercise-induced bronchospasm using an inhaler is albuterol.
- Key points:
- Albuterol is indicated for the relief of bronchospasm in patients with reversible obstructive airway disease.
- It is used for acute attacks of bronchospasm. 2
From the Research
First-Line Treatment for Exercise-Induced Bronchospasm
The first-line treatment for exercise-induced bronchospasm using an inhaler is typically a short-acting β2-agonist (SABA) such as albuterol 3.
Key Characteristics of Albuterol
- Albuterol is a long-acting beta 2-adrenergic receptor-selective drug that relaxes airway smooth muscle 4.
- It is available in various forms, including metered-dose inhalers, which are commonly used for the treatment of asthma and exercise-induced bronchospasm.
- Albuterol can produce undesirable dose-related effects, but these are less prominent with aerosol administration compared to parenteral administration 4.
Efficacy of Albuterol in Exercise-Induced Bronchospasm
- Studies have shown that albuterol is effective in preventing exercise-induced bronchoconstriction when used immediately before exercise 5, 6.
- However, regular use of albuterol four times daily for a week can worsen exercise-induced bronchoconstriction, although it remains effective when used immediately before exercise 5.
- A single dose of albuterol can provide protection against exercise-induced bronchospasm for at least 2-3 hours 6.
Comparison with Other Treatments
- Other treatments, such as salmeterol, may offer longer protection against exercise-induced bronchospasm, with a single 50-microgram dose providing effective protection for at least 12 hours in asthmatic children 6.
- Montelukast, a leukotriene antagonist, may also be an appropriate choice for some patients, particularly those who have difficulty with inhaled medications or experience side effects with albuterol 7.
Key Points to Consider
- The choice of treatment for exercise-induced bronchospasm should be individualized based on the patient's specific needs and medical history.
- Patients should be educated on the proper use of their inhaler and the importance of using their medication as directed to achieve optimal results.
- Regular monitoring and follow-up with a healthcare provider are essential to ensure that the treatment plan is effective and to make any necessary adjustments.