How should I manage a patient with exercise-induced asthma who wishes to participate in competitive sports?

For a patient with exercise-induced asthma who wishes to participate in competitive sports, the primary goal is to achieve complete asthma control, which includes no limitations on activity, including exercise ¹.

A key management strategy involves the use of an anti-inflammatory reliever (AIR) therapy, specifically a low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler, to be taken as needed for symptom relief and before exercise ². This approach has been shown to significantly reduce severe asthma exacerbations ².

It is crucial to provide the patient with a personalised asthma action plan, which should be reviewed at every asthma-related healthcare attendance and at annual review ². This plan should advise on individualised triggers, how to recognise early signs of an asthma exacerbation, and specific instructions on medication adjustments, including when to use oral prednisolone if needed ².

Regular physical activity is beneficial for general health and can improve symptoms and quality of life in people with moderate or severe asthma ². Therefore, supporting the patient's participation in competitive sports is in line with general health recommendations ².

At every asthma review, whether routine or unscheduled, and at every asthma-related consultation, it is essential to observe the patient using their inhaler device to ensure correct technique ¹. Incorrect inhaler technique and poor adherence increase the risk of uncontrolled asthma and future exacerbations ².

Monitor asthma control at every review, checking for symptoms, time off work or school due to asthma, amount of reliever inhaler used, number of oral corticosteroid courses, and any hospital admissions or emergency department attendances due to asthma ¹. Consider using a validated symptom questionnaire to assess control ¹.