Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges

Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.

Automated summary

Athletes often suffer from lower airway dysfunction, including asthma and exercise-induced bronchoconstriction (EIB), which affects more than half of the athletes in certain sports, especially endurance sports. Early diagnosis and proper management are crucial as untreated or poorly managed asthma and EIB can negatively impact performance and lead to airway damage. However, with advancements in treatment strategies, athletes with asthma and EIB can still compete at a high level. It is important for practitioners and athletes to adhere to general guidelines and anti-doping regulations to avoid unintentionally exceeding dosage limits.