How Should Exercise-Induced Asthma Be Treated? Posted By : Franchis

Tag : montelukast sodium
How Should Exercise-induced Asthma Be Treated?
Treating exercise-induced asthma is preventive. Several agents seemto be effective and are easily adapted for both children andadults.

B2-Adrenergic Agonists


The B2-adrenergic agonists are effective in preventingexercise-induced asthma. If a short-acting agent is given ten tofifteen minutes before exertion the immediate bronchoconstrictionmay be completely blocked. The long-acting B2-agonists such as

salmeterol may be particularly helpful since their lengthy durationmay also block the late phase attack. Remember, however, thatlong-acting B-agonists take longer to become effective so should begiven thirty to forty-five minutes before exercise begins.

B-Agonists for Children

In young children a metered-dose inhaler (MDI) may be difficult touse, so a spacer with or without a face mask may improvemedication. Some children, particularly those younger than agefive, may benefit more from a nebulizer that administers theB-agonist. Another alternative for young children is the oral syrupform of B-agonist taken at least sixty minutes before exercising.

Anti-Leukotrienes

Leukotrienes have been shown to playa central role inexercise-induced asthma. An anti-leukotriene agent (zafirlukast,montelukast, zileuton) may be added to the treatment ofexercise-induced asthma when the B2-adrenergic agonists are notcompletely effective. It should be noted that these agents aretaken orally and must be maintained on a regular basis

to be effective. Patients who are maintained on anti-leukotrieneagents should continue to use their B2-adrenergic agonist prior toexercise.

Cromolyn Sodium and Nedocromil Sodium

Cromolyn sodium and nedocromil sodium can also preventexercise-induced asthma and are an alternative to the B-agonists.In patients with moderate or severe asthma both groups of agentsmay be used together. Cromolyn and nedocromil can also block thelate phase of exercise-induced asthma, but their onset of actionmay be even slower than the short-acting B-agonists. One studycomparing cromolyn and albuterol to prevent exercise-induced asthmafound albuterol more effective.

Theophylline

Theophylline can also prevent exercise-induced asthma but isclearly less effective than the B-agonists, cromolyn, andnedocromil. Inhaled corticosteroids cannot prevent the immediateeffects of exercise but their use in asthma maintenance therapywould help prevent late phase reactions.

Approved Medications

The NCAA and the International Olympic Committee maintain lists ofacceptable medications for athletes. Medications approved by theUnited States Olympic Committee include B-agonists (aerosol formsonly), albuterol, and terbutaline, as well as cromolyn sodium,nedocromil sodium, theophylline, and inhaled corticosteroids.
By: Franchis
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