What works best for exercise-induced asthma?

Published online February 26, 2025

People with asthma frequently experience breathing difficulties such as shortness of breath, coughing, chest tightness, or wheezing during or after exercise. This condition is referred to as exercise-induced bronchospasm (EIB), which can significantly impact daily activities and overall quality of life. While numerous treatment options exist, it is not always clear which one is better while minimizing potential risks.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Vichara-anont and Lumkul et al. reviewed and analyzed data from previous randomized controlled trials using a systematic review and network meta-analysis framework. Eleven RCTs involving 1,054 adolescent and adult asthma patients with EIB were included to assess the effectiveness and safety of asthma maintenance treatments, such as inhaled corticosteroids (ICS), ICS combined with long-acting bronchodilators, and montelukast. Following the use of those therapies, improved breathing difficulties after exercise were evaluated.

For people with mild asthma with EIB, using a low-dose ICS inhaler daily or a combo inhaler with ICS and a fast-acting bronchodilator (like formoterol) when needed can be a helpful starting option. This can lower the need to rely too much on quick-relief inhalers. For those with more serious conditions, adding a daily pill like montelukast or a long-acting bronchodilator (like salmeterol) to the ICS might be needed. It's important to keep a close eye on how well the treatment is working and watch for any side effects.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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