An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma. METHODS: To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting ß(2)-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting ß(2)-agonist before exercise, strong recommendations were made for a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise. CONCLUSIONS: The recommendations in this Guideline reflect the currently available evidence. New clinical research data will necessitate a revision and update in the future.

Palliative and end-of-life care training during the surgical clerkship.

BACKGROUND: In 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine. MATERIALS AND METHODS: In the 2007-08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback. RESULTS: All 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024). CONCLUSIONS: Early training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, "Conducting a Family Conference" proved to be the most challenging.

Exercise-induced bronchoconstriction and vocal cord dysfunction: two sides of the same coin?

Patients are referred often because of self-reported symptoms of dyspnea and wheeze during exercise. The two common causes of exercise-induced dyspnea are exercise-induced bronchoconstriction (EIB) and vocal cord dysfunction (VCD). It can be extraordinarily difficult to differentiate between the two, especially because they may coexist in the same patient. EIB is caused by bronchial smooth muscle constriction in the lower airways due to the inhalation of dry air or allergens during exercise; it is associated with the release of bronchoconstricting mediators from airway cells. EIB can occur in patients with or without persistent asthma. In contrast, VCD is associated with the paradoxical adduction of the vocal cords, especially during inhalation, which may produce inspiratory stridor. VCD can be solitary or comorbid with asthma and/or EIB. EIB classically is most severe after the cessation of exercise, while VCD typically occurs during exercise and resolves quickly upon exercise cessation. However, history is not adequate to differentiate between EIB and VCD, and appropriate challenge tests and flexible laryngoscopy during exercise are often necessary for diagnosis. This article examines our current understanding of these entities and discusses the mechanism, prevalence, diagnosis, and treatment.

Inhaled whole exhaust and its effect on exercise performance and vascular function.

CONTEXT: Internal combustion engines are a major source of particulate matter (PM) which has been shown to result in vasoconstriction, yet no present study to our knowledge has investigated the effect of exhaust emissions on both exercise performance and the vasculature. OBJECTIVE: To examine the effect of freshly generated whole exhaust on exercise performance, pulmonary arterial pressure (PP), and flow-mediated vasodilation (FMD) of the brachial artery. MATERIALS AND METHODS: Sixteen male, collegiate athletes (age: 20.8±1.28 years) were randomly assigned to submaximal exercise for 20 min followed by a 6 min maximal work accumulation exercise test in either high PM (HPM) or low PM (LPM) conditions on two consecutive days. After a 7-day washout period, subjects completed identical exercise trials in the alternate condition. HPM conditions were generated from a 4-cycle gasoline engine. The participants' PP and FMD were assessed before and after each exercise trial by tricuspid regurgitant velocity and brachial artery imaging, respectively. RESULTS: Total work (LPM: 108.0±14.8 kJ; HPM: 104.9±15.2 kJ, p=0.019) and FMD (LPM: 8.17±6.41%; HPM: 6.59±2.53%; p=0.034) significantly decreased in HPM while PP was significantly increased (LPM: 16.9±1.13 mmHg; HPM: 17.9±1.70 mmHg; p=0.004). A significant correlation was identified between the change in exercise performance and the change in FMD (r=0.494; p=0.026) after the first HPM trial. CONCLUSION: Exercise performance declined in HPM conditions in part due to impaired vasodilation in the peripheral vasculature.

Reproducibility of the airway response to an exercise protocol standardized for intensity, duration, and inspired air conditions, in subjects with symptoms suggestive of asthma.

BACKGROUND: Exercise testing to aid diagnosis of exercise-induced bronchoconstriction (EIB) is commonly performed. Reproducibility of the airway response to a standardized exercise protocol has not been reported in subjects being evaluated with mild symptoms suggestive of asthma but without a definite diagnosis. This study examined reproducibility of % fall in FEV1 and area under the FEV1 time curve for 30 minutes in response to two exercise tests performed with the same intensity and duration of exercise, and inspired air conditions. METHODS: Subjects with mild symptoms of asthma exercised twice within approximately 4 days by running for 8 minutes on a motorized treadmill breathing dry air at an intensity to induce a heart rate between 80-90% predicted maximum; reproducibility of the airway response was expressed as the 95% probability interval. RESULTS: Of 373 subjects challenged twice 161 were positive (≥ 10% fall FEV1 on at least one challenge). The EIB was mild and 77% of subjects had <15% fall on both challenges. Agreement between results was 76.1% with 56.8% (212) negative (< 10% fall FEV1) and 19.3% (72) positive on both challenges. The remaining 23.9% of subjects had only one positive test. The 95% probability interval for reproducibility of the % fall in FEV1 and AUC0-30 min was ± 9.7% and ± 251% for all 278 adults and ± 13.4% and ± 279% for all 95 children. The 95% probability interval for reproducibility of % fall in FEV1 and AUC0-30 min for the 72 subjects with two tests ≥ 10% fall FEV1 was ± 14.6% and ± 373% and for the 34 subjects with two tests ≥ 15% fall FEV1 it was ± 12.2% and ± 411%. Heart rate and estimated ventilation achieved were not significantly different either on the two test days or when one test result was positive and one was negative. CONCLUSIONS: Under standardized, well controlled conditions for exercise challenge, the majority of subjects with mild symptoms of asthma demonstrated agreement in test results. Performing two tests may need to be considered when using exercise to exclude or diagnose EIB, when prescribing prophylactic treatment to prevent EIB and when designing protocols for clinical trials.

Montelukast prevents vascular endothelial dysfunction from internal combustion exhaust inhalation during exercise.

Associations between high particulate matter (PM) pollution and increased morbidity and mortality from coronary heart disease have been identified. This study assessed leukotriene (LT) participation in PM-induced vascular endothelial dysfunction. Ten healthy males exercised 4 times for 30 min in both high PM (550,286 +/- 42,004 particles x cm(-3)) and low PM (4571 +/- 1922 particles x cm(-3)) after ingesting placebo (PL) or 10 mg montelukast (MK; half-life 3-6 h), a leukotriene receptor antagonist. Brachial artery flow-mediated dilation (FMD) was measured pre- and 30 min, 4 h, 24 h post-exercise. No basal brachial artery vascoconstriction was evident from high PM exercise. High PM blunted FMD, whereas high PM MK, low PM PL, and low PM MK demonstrated normal FMD (p < .003). Change in FMD (pre- to post-exercise) for high PM PL was different than for high PM MK, low PM PL, and low PM MK at 30 min post-exercise (p < .007). At 4 h, high PM MK FMD blunting increased (p = .1). At 24 h, high PM FMD blunting persisted (p < .05); no difference was observed between high PM PL or MK treatment, but was different that low PM PL/MK treatments (p < .05). MK blocked high PM post-exercise FMD blunting and maintained normal response, suggesting that leukotrienes are involved in PM-initiated vascular endothelial dysfunction.

Grade influences blood lactate kinetics during cross-country skiing.

The purpose of this study was to examine the effects of level vs. graded skate skiing on capillary blood lactate (B(La)), heart rate (HR), oxygen consumption (V(O2)), and training intensity prescriptions. Eleven Nordic skiers completed 2 submaximal skate roller skiing treadmill protocols during which intensity was increased either by grade (G(inc)) or by speed (S(inc)). The protocols were compared for prethreshold BLa, HR, and V(O2) at lactate threshold (LT) and the HR/V(O2) relationship. Additionally, double-pole (primarily upper body) and skating (arms and legs combined) protocols were used to measure peak V(O2) and peak HR. Heart rate and V(O2) at LT were lower during G(inc) compared with S(inc) (154.9 +/- 6.8 b.min(-1) vs. 162.0 +/- 9.1 b.min(-1) and 46.3 +/- 2.8 ml.kg(-1).min(-1) vs. 49.1 +/- 1.6 ml.kg(-1).min(-1), respectively, both p < 0.01). Pre-threshold B(La) and the HR/V(O2) relationship were not different between the submaximal protocols. V(O2) and HRpeak were higher in skating compared with double poling (64.6 +/- 1.8 ml.kg(-1).min(-1) vs. 60.3 +/- 2.8 ml.kg(-1).min(-1), 192.6 +/- 5.8 b.min(-1) vs. 187.8 +/- 6.7 b.min(-1), respectively, both p < 0.01). Greater reliance on upper-body musculature during graded skiing and its associated lower aerobic capacity increases B(La) when compared with level skiing. The leftward shift in the B(La) vs. intensity curve during uphill skiing should be recognized to properly prescribe training intensity as well as interpret laboratory results.

Peak power during repeated wingate trials: implications for testing.

Maximal power production is of primary importance for many sporting events. Therefore, using a test that has been shown to be both valid and reliable will allow for accurate baseline testing, measurement of progress, and evaluation of performance. This study examined peak power (PP) during repeated Wingate trials after no warm-up (NWU), a steady state warm-up, and an interval warm-up. In a randomized placebo-controlled study, 11 subjects (38 +/- 8.2 years) performed two 10-second Wingate trials with 4 minutes of recovery between efforts. Warm-up protocols were completed before each Wingate trial and were immediately followed by trial I. Peak power was measured during each trial. Results indicate that PP is not significantly (p > 0.05) different from trial I to trial II for either of the warm-up protocols. The NWU trial II was significantly greater than the NWU trial I (855 +/- 230 W > 814 +/- 222 W, p < 0.05) when analyzed with a paired samples t-test. Peak power appears to be greatest after a general self-selected warm-up, but not after a previously intense bike warm-up. When testing for maximal power output via the Wingate anaerobic test, one should allow for a familiarization trial and should ensure full recovery between this trial and the baseline evaluation.

Asthma in swimmers: a review of the current literature.

Asthma is common in many types of athletes, but its prevalence appears to be particularly high in swimmers. Long-term and acute exposure to swimming pool disinfectants has been shown to increase asthma risk in swimmers through inducing oxidative stress, which results in inflammation of the pulmonary epithelium and subsequent airway remodeling. Individuals with specific genotypes are more likely to develop asthma when exposed to inhaled irritants. Therefore, it is important for physicians to be knowledgeable about the risks associated with asthma in swimmers, as well as the diagnostic techniques and practices to reduce asthma symptoms.

Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes.

The prevalence of exercise-induced bronchoconstriction is reported to be high among recreational and elite athletes, yet diagnosis is often symptom-based. Indirect challenges such as the laboratory exercise challenge provide objective criteria for proper diagnosis and treatment. However, a standardized protocol using appropriate exercise intensity, duration, and dry air inhalation is often not implemented, and thus a false-negative test may result. This article reviews and describes the symptom-based diagnosis, the exercise challenge, and other indirect challenges such as eucapnic voluntary hyperpnea, hypertonic saline inhalation, and inhaled powdered mannitol as methods to diagnose and evaluate exercise-induced bronchoconstriction. Advantages and disadvantages of each diagnostic procedure are presented.

Asthma and the elite athlete: summary of the International Olympic Committee's consensus conference, Lausanne, Switzerland, January 22-24, 2008.

Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled beta(2)-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to beta(2)-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale beta(2)-agonists will continue.

Imitators of exercise-induced bronchoconstriction.

Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.

Decreased lung function after inhalation of ultrafine and fine particulate matter during exercise is related to decreased total nitrate in exhaled breath condensate.

This study was designed to investigate PM(1) inhalation during exercise on lung function, exhaled nitric oxide (eNO), and total nitrate (NO3), S-nitrosoglutathione (GSNO), and malondialdehyde (MDA) in exhaled breath condensate (EBC). Inhalation of combustion-derived PM is associated with adverse respiratory health. A mechanistic action of PM on lung function is not defined; however, nitrosative/oxidative stress is likely. Prior to and after two 30-min exercise bouts 4-5 days apart, inhaling low (7382 +/- 1727 particles cm(- 3)) or high (252,290 +/- 77,529 particles cm(- 3)) PM(1), 12 nonasthmatic males performed spirometry and eNO and EBC collection. Normal resting lung function did not change after low PM(1) exercise. After high PM(1) exercise, FEV(1) and FEF(25-75) fell significantly (p = .0005, p = .002) and was related to [PM(1)] (r = -.55, p = .005 and r =-.61, p = .002; respectively); 11- and 52-ml decreases were calculated for each 20,000 particles cm(- 3) increase for FEV and FEF(25-75). NO3 did not change after low PM(1) exercise (30.5% increase), but significantly decreased by 43.8% after high PM(1) exercise, and correlated with lung function changes (r = .63, and r = .54 for FEV(1) and FEF(25-75), respectively; p = .001 and p = .007). No change in GSNO was observed. Alveolar NO decreased after high PM(1) conditions (p = .02); eNO pre-to-post difference was related to changes in FEV(1) (r = .60, p = .002). MDA increased 40% after low PM exercise (NS) and increased 208% after high PM exercise (p = .06). Thus, high PM(1) inhalation during exercise caused a reduced alveolar contribution to eNO; NO3 and eNO variables were decreased and were related to impaired lung function. Decreased NO(3) and eNO may be due to superoxide/NO formation of peroxynitrite, resulting in lipid peroxidation.

Ultrafine and fine particulate matter inhalation decreases exercise performance in healthy subjects.

The purpose of this study was to investigate effects of PM1 (particulate matter with aerodynamic diameter 0.02-2 microm) inhalation on exercise performance in healthy subjects. Inhalation of internal combustion-derived PM is associated with adverse effects to the pulmonary and muscle microcirculation. No data are available concerning air pollution and exercise performance. Fifteen healthy college-aged males performed 4 maximal effort 6-min cycle ergometer trials while breathing low or high PM1 to achieve maximal work accumulation (kJ). Low PM1 inhalation trials 1 and 2 were separated by 3 days; then after a 7 day washout, trials 3 and 4 (separated by 3 days) were done while breathing high PM1 generated from a gasoline engine; CO was kept below 10 ppm. Lung function was done after trial 1 to verify nonasthmatic status. Lung function was normal before and after low PM1 exercise. PM1 number counts were not different between high PM1 trials (336,730 +/- 149,206 and 396,200 +/- 82,564 for trial 3 and 4, respectively) and were different from low PM1 trial number counts (2,260 +/- 500) (P < 0.0001). Mean heart rate was not different between trials (189 +/- 6.0, 188 +/- 7.6, 188 +/- 7.6, 187 +/- 7.4, for low and high PM1 trials; respectively). Work accumulated was not different between low PM1 trials (96.1 +/- 9.38 versus 96.6 +/- 10.83 kJ) and the first high PM1 trial (trial 3, 96.8 +/- 10.65 kJ). Work accumulated in the second high PM1 trial 4, 91.3 +/- 10.04 kJ) was less than in low PM1 trials 1 and 2, and high PM1 trial 3 (P = 0.004, P = 0.003, P = 0.0008; respectively). Acute inhalation of high (PM1) typical of many urban environments could impair exercise performance.

Exercise-Induced Bronchoconstriction and the Air We Breathe.

An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.

Inhalation of ultrafine and fine particulate matter disrupts systemic vascular function.

This study investigated the effects of particulate matter (PM) with aerodynamic diameter 0.02-1 microm (noted as PM1) inhalation during exercise on conduit artery and microvascular function. Inhalation of internal combustion-derived PM is associated with cardiovascular mortality and morbidity. Direct action of PM on the vascular endothelium is likely, as a substantial fraction of ultrafine PM translocates from the alveoli to the circulatory system. Sixteen intercollegiate athletes performed 30 min of exercise while inhaling low or high PM1. Flow-mediated brachial artery dilation (FMD) using high-resolution ultrasonography with simultaneous measurements of forearm oxygen kinetics using near infrared spectrophotometry (NIRS) was done before and after exercise. Basal brachial artery vasoconstriction was found after high PM1 exercise (4.0%, 4.66 +/- 0.609 to 4.47 +/- 0.625 mm diameter; p = .0002), but not after low PM1 exercise (-0.3%, 4.66 +/- 0.626 to 4.68 +/- 0.613 mm diameter). FMD was impaired after high PM1 exercise (6.8 +/- 3.58% for preexercise FMD and 0.30 +/- 2.74% for postexercise FMD, p = .0001), but not after low PM1 exercise (6.6 +/- 4.04% for preexercise FMD and 4.89 +/- 4.42% for postexercise FMD). Reduction in forearm muscle reperfusion estimated by reoxygenation slope-to-baseline after 4 min cuff ischemia was observed for high PM1 exercise (55% vs. 3%, p = .0006); no difference was noted for low PM1 exercise. Brachial artery FMD was significantly correlated to muscle reoxygenation slope-to-baseline (r = .50, p = .005). Acute inhalation of high [PM1] typical of urban environments impairs both systemic conduit artery function and microcirculation. The observed decrease reoxygenation slope-to-baseline after cuff release is consistent with reduced blood flow in the muscle microvasculature.

Prevalence of allergy and asthma symptoms in recreational roadrunners.

PURPOSE: The prevalence of allergy and asthma symptoms and asthma medication use, which has been extensively studied in elite athletes, has received little attention in recreational roadrunners. METHODS: A validated questionnaire was used to determine the prevalence of allergy and asthma symptoms, the use of medication, and allergy specialty attention among recreational roadrunners. Comparison with the published prevalence of allergy and asthma symptoms in Olympic athletes was made. RESULTS: The prevalence of allergy and asthma symptoms were similar in two consecutive yearly surveys (2003, 2004). The response from 2004 was 11% (484 of 4398 runners). The study population was 60% male, 56% Caucasian, 10% non-Caucasian, and 34% undesignated. Subjects competed for 13.2 +/- 10.5 yr. Prevalence was 44% for symptoms of allergy, 31% for asthma, and 21% for both. Of those reporting allergy symptoms alone, 0.5% had prescription medications or medication before the race. Those with asthma and allergy or asthma alone were more likely to have prescription medication (allergy and asthma, 32%, P = 0.0001; asthma, 6%, P = 0.001), to take medication before the race (asthma and allergy, 27%, P = 0.0001; asthma, 5%, P = 0.007), or to seek specialty attention and medication (asthma and allergy, 39%, P = 0.0001; asthma, 7%, P = 0.004) than those with allergy symptoms alone. The comparison with results from a survey of Olympic athletes indicates that symptoms of allergy and asthma were more prevalent in recreational athletes (P = 0.0001 to 0.007), but roadrunners were less likely to be taking prescription medication (P = 0.025). CONCLUSION: These results suggest that the recreational roadrunner is more likely to report symptoms of allergy and/or asthma but less likely to have prescription medication than the Olympic athlete.

Vehicular air pollution, playgrounds, and youth athletic fields.

In spite of epidemiological evidence concerning vehicular air pollution and adverse respiratory/cardiovascular health, many athletic fields and school playgrounds are adjacent to high traffic roadways and could present long-term health risks for exercising children and young adults. Particulate matter (PM(1),0.02-1.0 microm diameter) number counts were taken serially at four elementary school athletic/playground fields and at one university soccer field. Elementary school PM1 measurements were taken over 17 days; measurements at the university soccer field were taken over 62 days. The high-traffic-location elementary school field demonstrated higher 17-day [PM1] than the moderate and 2 low traffic elementary school fields (48,890 +/- 34,260, 16,730 +/- 10,550, 11,960 +/- 6680, 10,030 +/- 6280, respective mean counts; p < .05). The 62-day mean PM1 values at the university soccer field ranged from 115,000 to 134,000 particles cm(-3). Lowest mean values were recorded at measurement sites furthest from the highway (approximately 34,000 particles cm(-3)) and followed a second-order logarithmic decay (R2 = .999) with distance away from the highway. Mean NO2 and SO2 levels were below 100 ppb, mean CO was 0.33 +/- 1.87 ppm, and mean O3 was 106 +/- 47 ppb. Ozone increased with rising temperature and was highest in the warmer afternoon hours (R = .61). Although the consequence of daily recess play and athletic activities by school children and young athletes in high ambient [PM1] conditions has not yet been clearly defined, this study is a critical component to evaluating functional effects of chronic combustion-derived PM exposure on these exercising schoolchildren and young adults. Future studies should examine threshold limits and mechanistic actions of real-world particle exposure.

Airway narrowing measured by spirometry and impulse oscillometry following room temperature and cold temperature exercise.

STUDY OBJECTIVE: The efficacy of using impulse oscillometry (IOS) as an indirect measure of airflow obstruction compared to spirometry after exercise challenges in the evaluation of exercise-induced bronchoconstriction (EIB) has not been fully appreciated. The objective was to compare airway responses following room temperature and cold temperature exercise challenges, and to compare whether IOS variables relate to spirometry variables. DESIGN: Spirometry and IOS were performed at baseline and for 20 min after challenge at 5-min intervals. SETTING: Two 6-min exercise challenges, inhaling either room temperature (22.0 degrees C) or cold temperature (- 1 degrees C) dry medical-grade bottled air. At least 48 h was observed between these randomly assigned challenges. PARTICIPANTS: Twenty-two physically active individuals (12 women and 10 men) with probable EIB. INTERVENTIONS: Subjects performed 6 min of stationary cycle ergometry while breathing either cold or room temperature medical-grade dry bottled air. Subjects were instructed to exercise at the highest intensity sustainable for the duration of the challenge. Heart rate and kilojoules of work performed were documented to verify exercise intensity. MEASUREMENTS AND RESULTS: Strong correlations were observed within testing modalities for post-room temperature and post-cold temperature exercise spirometry and IOS values. Spirometry revealed no differences in postexercise peak falls in lung function between conditions; however, IOS identified significant differences in respiratory resistance (p < 0.05), with room temperature-inspired air being more potent than cold temperature-inspired air. CONCLUSIONS: Correlations were found between spirometric and IOS measures of change in airway function for both exercise challenges, indicating close equivalency of the methods. The challenges appeared to elicit the EIB response by a similar mechanism of water loss, and cold temperature did not have an additive effect. IOS detected a difference in degree of response between the temperatures, whereas spirometry indicated no difference, suggesting that IOS is a more sensitive measure of change in airway function.