Study: EIB may affect lives and health of public if not addressed properly

For the vast majority of the general public, respiratory symptoms such as shortness of breath, wheezing or coughing are a common part of the exercise experience. However, together with chest tightness, noisy breathing and trouble taking a deep breath, these six symptoms make up the phenomenon known as exercise-induced bronchospasm (EIB), which has physical, emotional and psychological consequences if not addressed properly. The impact of EIB on the lives and health of the public was assessed in "EIB: A Landmark Survey," the first comprehensive national survey of the public, asthma patients and healthcare providers about exercise-related respiratory symptoms in the U.S. Findings from the survey were released by Teva Respiratory at the American Academy of Allergy Asthma & Immunology (AAAAI) Annual Meeting, held Feb. 26-March 2, 2010, in New Orleans, La.

For people with asthma, understanding the interaction between exercise and their asthma is critical for having a better quality of life. According to the survey, exercise and weather are the two strongest triggers of symptoms for people with asthma, and the experience of exercise-related symptoms is one of the reasons that people with asthma limit or even avoid activities. In fact, 46% of adults and 26% of children avoid activities that they would like to do because of their exercise-induced symptoms.

"Many people don't realize they have EIB because they think these are their body's normal responses to working out. Physical exertion may be the only thing that triggers your symptoms, and in the case of people diagnosed with asthma, it may be one of several triggers," says Timothy Craig, D.O., Professor of Medicine and Pediatrics, Penn State University College of Medicine. "But having EIB doesn't mean you should avoid exercise. Proper treatment and precautions can help you stay active – whether you're taking a leisurely walk or competing as a professional athlete."  

In the survey, a full 82% of the asthma population reported experiencing at least one of the six symptoms during exercise, and 22% of asthma sufferers experience all six. Despite this high prevalence, a startling 78% of asthma patients have undiagnosed EIB. Similarly high figures were observed in the general population arm of the study, where 65% of the public (includes asthma sufferers) experienced at least one symptom during exercise and were not diagnosed with EIB. These findings underscore the need for increased awareness and education about EIB among the general population, and particularly for asthma patients for whom exercise seems to pose additional challenges. Currently, only 22% of asthma sufferers have heard of EIB, suggesting that there are many who have symptoms but are unaware of what they are experiencing, and are potentially unaware that there is an effective way to prevent exercise-related symptoms from occurring.

According to the National Heart, Lung and Blood Institute's (NHLBI) National Asthma Education and Prevention Program (NAEPP) guidelines, EIB can be prevented by using a short-acting beta-agonist (SABA) such as albuterol prior to vigorous activity or exercise. The preference for pre-treating with a SABA was validated in the healthcare provider sample of the survey, where SABAs were most often cited as the class of medication with the highest therapeutic yield for adults and children with exercise-related symptoms. Furthermore, healthcare providers were strongly aligned (averaging 73%) on when quick-relief medicines like SABAs should be used, which was clearly prior to beginning exercise. Interestingly, the survey revealed that only 29% of asthma patients with undiagnosed EIB also believed that SABAs should be used before exercise, with this population being far more likely to use their quick-relief inhaler after they exercise (45%). Even those asthma patients who have been diagnosed with EIB are not using their inhaler as recommended by NAEPP – 43% use a SABA before exercise, while 47% use their inhaler after exercise.

"These findings underscore the need for physicians to continue educating patients about how to properly use albuterol when it comes to the prevention of exercise-related respiratory symptoms, because it's different from their regular asthma routine," states Dr. Craig. "While patients are used to taking their quick-relief inhalers in response to flare-up of symptoms, when it comes to exercise, it is crucial that they learn to use it beforehand to prevent an attack from coming on," Dr. Craig added.

While pre-treatment with a SABA is what doctors recommend for managing EIB symptoms, patients who have frequent, severe EIB should talk to their physician to evaluate the status of their underlying asthma. There may be a need to initiate or increase daily long-term control therapy since symptoms of EIB for those with asthma can be a sign that their asthma is not well controlled.

"EIB: A Landmark Survey" provides a comprehensive look at the experience of exercise-related symptoms and the impact on the lives of patients. The survey also provides healthcare professionals with insight into the gaps in patients' understanding of their asthma, and can be used as a tool when discussing which albuterol inhaler design is right for them. For example, some albuterol inhalers can be stored or carried in any position, while others have special instructions which require them to be stored upright in order to function as intended. Education combined with the right treatment will help patients with EIB better incorporate exercise into their lives and keep them on the road to better health.