Air trapping - exercise-induced asthma (EIA): pathomechanism, diagnosis and novel prevention strategies

<ns3:p>Background: Exercise-induced asthma (EIA), also known as exercise-induced bronchoconstriction (EIB), is characterized by transient airway narrowing triggered by physical exertion, leading to symptoms such as cough, wheezing, shortness of breath, and chest tightness. The pathophysiology of EIA involves osmotic and thermal mechanisms, resulting in the release of inflammatory mediators that induce bronchospasm.Aim of the study: This systematic review aims to elucidate the pathomechanisms, diagnostic approaches, and treatment modalities for EIA.Material and methods: The review follows PRISMA guidelines and includes 31 studies from PubMed and ClinicalTrials.gov, focusing on adults reporting EIA symptoms. Diagnostic methods primarily include spirometry pre- and post-exercise, with a ≥10% decrease in FEV1 indicating EIA. Provocation tests, such as eucapnic voluntary hyperventilation (EVH), and novel methods like diaphragm electromyography (EMGdi), are also explored.Results: Management strategies encompass pharmacological treatments, including short-acting beta-2 agonists (SABAs), inhaled corticosteroids (ICS), and leukotriene receptor antagonists (LTRAs), alongside non-pharmacological approaches like warm-up exercises and breathing retraining, which have been reviewed as parts of phase 3 and phase 4 clinical trials. The consistent use of standardised exercise challenge tests and FEV1 measurements, along with robust study designs, strengthens the evidence for prevention method efficacy.Conclusions: The review highlights the need for standardized diagnostic criteria and personalised treatment plans to improve patient outcomes and quality of life.</ns3:p>