Pharmacological Methods of EIB Treatment
The ATS guidelines for the general population with EIB showed that EIB can be present both in patients with and without confirmed asthma. They recommend taking a short-acting β2-agonist (SABA) inhalation 5-20 minutes prior to a planned exercise. When SABA dosing is more frequent but the patient still suffers from EIB symptoms, daily monotherapy with inhaled corticosteroids (ICS) is recommended, which are considered the most effective anti-inflammatory agents in EIB treatment. A long-acting β2-agonist (LABA) may be used if necessary. Among the drugs with protective effects against EIB, formoterol (LABA) in dry powder inhalation can prevent EIB within a few minutes after administration for a duration of at least 4 hours37. Among athletes who rarely experience EIB episodes, it is sufficient to administer SABA before exercise.
Daily use of a leukotriene receptor antagonist (LTRA) is also recommended. It should be taken about two hours before planned exercise, however its effects are smaller than in the case of SABA or ICS. As a second-line therapy, it is possible to use inhaled anticholinergic agents or a mast cell stabilizing agent before exercise. Among patients suffering from EIB and allergies, who use SABA only before exercise or in patients with daily and more frequent use of SABA – addition an antihistamine is recommended.
Ducharme F. emphasizes that for adults with a mild or moderate asthma it has been demonstrated that equivalent to 400 g / day beclomethasone is more effective than leukotriene receptor antagonists. The authors suggest that among treated children there is insufficient evidence to detect the efficacy of leukotriene antagonists, but others argue that anti-leukotriene drugs should remain a treatment option for the athletes with EIB when SABA and ICS therapy is insufficient38.