Metered-Dose Inhalers for Young Athletes With Exercise-Induced Asthma

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Abstract
Bronchoconstriction can occur in association with exercise in up to 15% of the general population, including nearly 100% of people with asthma, 35% to 40% of those with allergic rhinitis, and some who have no other evidence of allergy.1 This phenomenon, termed exercise-induced asthma (EIA), is manifested by coughing, choking, chest pain, easy fatigability, shortness of breath, wheezing, chest tightness, or any combination of these symptoms during, or especially after, exercise. In a child known to have asthma or nasal allergies, the diagnosis of EIA can usually be made on the basis of history alone. Repeated episodes of increased difficulty breathing or cough in association with physical exertion should be assumed to be EIA until proved otherwise. Sophisticated pulmonary function testing is not necessary in the majority of cases. In the atypical case, pulmonary function testing, often in conjunction with an exercise challenge, can confirm the diagnosis. Exercise-induced asthma is less likely to occur in a child whose asthma is well controlled,1 a goal accomplished best with attention to the role of airway inflammation as well as bronchoconstriction.2 Fortunately, EIA can be controlled in most athletes by the inhalation of a β2-agonist bronchodilator (eg, albuterol), cromolyn sodium, or both 15 to 30 minutes before exercise. These safe medications come in several different forms, but the most convenient for patients older than 2 or 3 years is the pressurized metered-dose inhaler (MDI), which is especially easy to use with the addition of a spacing device. Cromolyn has never been thought to be effective as an ergogenic (performance-enhancing) aid,3 and only two studies have suggested the possibility that albuterol is ergogenic.4,5

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