WHAT TYPE OF EXERCISE TEST SHOULD BE DONE TO DIAGNOSE EXERCISE-INDUCED BRONCHIAL ASTHMA?

A true exercise induced allergic bronchia asthma is very rare and is often over iagnosed. This is because most of the patients having 'chronic allergic bronchial asthma', with mild symptoms at rest, develop more dyspnoea on exertion. Therefore, only if a patient is not asthmatic at rest, should the diagnosis of exercise-induced allergic bronchial asthma be considered.

The following interesting facts are worth noting:-

1.	Unlike discomfort of exercise induced angina pectoris, which occurs ‘during the exertion’, exercise-induced bronchial asthma occurs 3-5 minutes “after” stopping the exercise.
2.	Often, the symptoms reach the peak after 10-15 minutes and may last upto 1 hour (maximum).

This type of asthma occurs more often in cold countries.

In the past I have stressed the importance of the report of Stress Treadmill Test. While reading this report to diagnose Ischaemic Heart Disease, it is also necessary to see the findings ‘5 minutes after the stoppage of exercise’, because sometimes, the ST changes or arrhythmias appear only during that period.

While seeing the results of exercise-test done in a Pulmonary function laboratory, where either the patient’s FEV1 or SPO2, or any other lung function is monitored, it is vital not to forget to see- if the operator has followed up the patient for 10 minutes after exercise. If there has been no follow-up, the patient should be sent back to the Pulmonary Function Lab, with a request to repeat the test and give the findings ‘10 minutes after stopping the exercise’.

The management of these patients is not difficult and the prophylactic use of inhalers is often very successful in their treatment.