The problem of exercise induced asthma (EIA) in elite athletes was first recognised because of the disproportionately high numbers of athletes at the elite level using β₂ agonists for asthma treatment during competition. In response to this problem, the International Olympic Committee’s Medical Commission (IOC-MC) and other major sporting bodies have instituted guidelines requiring objective evidence of asthma to permit medication use by elite athletes in competition.¹ These guidelines have highlighted the need for bronchial provocation challenge tests in the diagnosis of asthma in the elite athlete group.

Exercise induced bronchoconstriction (EIB)

EIA describes the transitory increase in airway resistance that occurs following vigorous exercise.² However, because exercise may be the only provoking factor in some patients, especially in elite athletes where there are no other symptoms or signs of asthma, the term “exercise induced bronchoconstriction” (EIB) may be more appropriate. This allows the separation of a physiological response from a disease.³

Problems with diagnosing EIB

Emerging data suggest that the clinical diagnosis of EIB is relatively inaccurate. Rundell and co-workers found that only 61% of athletes positive to a field exercise challenge test reported symptoms while 45% of those negative to the challenge also reported symptoms.⁴ Similar findings were reported in a study of 50 elite Australian summer sport athletes by Holzer and co-workers⁵ in which seven of the 26 athletes (27%) with a positive challenge test for EIB reported no exercise related respiratory symptoms, and only 24 of the 34 athletes (71%) who reported symptoms had a positive bronchial provocation challenge test. These findings indicate that some athletes who are clearly symptomatic after exercise …