Stress-induced bronchoconstriction. Consensus document of the Spanish Society of Sports Medicine (SEMED)

There is extensive evidence of the beneficial effects of training and rehabilitation programs on diseases, including asthma. In the latter, physical activity has been shown to improve symptoms, quality of life, exercise capacity, lung function, strengthen respiratory muscles, reduce airway inflammation in asthmatics, and prevent and treat osteoporosis secondary to corticosteroid therapy. Physical exercise can cause reversible airflow obstruction in both patients diagnosed with bronchial asthma and non-asthmatic patients, with the subsequent appearance of symptoms such as dyspnea, cough, chest pain, and/or wheezing. Exercise-induced asthma (EIA) and exercise-induced bronchospasm (EIB) are often used interchangeably, but EIA is thought to respond to an underlying chronic bronchial inflammatory process, while EIB is due to an acute response of the bronchial tree to various stimuli. Some athletes may only experience symptoms in response to exercise in a very specific environment. Therefore, the most comprehensive definition of EIB is objective evidence of bronchial hyperreactivity in response to various pulmonary stressors encountered during exercise, which may or may not present with typical respiratory symptoms. The pathophysiology of asthma should be understood, and physical exercise should be prescribed individually, as if it were a medication (intensity, type, duration, frequency, and progression). Except in competitive athletes, intense physical exercise should be avoided, as it can trigger airway symptoms by placing high demands on the respiratory system and exposing subjects to increased amounts of allergens. This consensus document reviews and updates the concepts of exercise-induced bronchoconstriction, its prevalence, diagnosis, differential diagnosis, treatment, prevention, and the considerations that should be made regarding its treatment in athletes in relation to anti-doping regulations.