Mast‐cell stabilising agents to prevent exercise‐induced bronchoconstriction

Background Exercise‐induced bronchoconstriction (or asthma) following strenuous physical exertion is common and can cause sub‐optimal performance, symptoms such as cough, dyspnea, wheeze, chest tightness, and can lead people to avoid physical activity. Management focuses on prevention with pre‐exercise treatment using various pharmacologic agents. Mast cell stabilizing agents are effective in attenuating exercise‐induced bronchoconstriction but their effectiveness compared to bronchodilator agents is unclear. Objectives To quantitatively compare the effects of inhaling a single dose of either mast cell stabiliser ‐ nedocromil sodium or sodium cromoglycate ‐ to a single dose of short acting beta‐agonists or anti‐cholinergic agents ‐ atropine or ipratropium bromide ‐ prior to a strenuous exercise challenge in participants with asthma who are at least 6 years of age and suffer from reproducible exercise‐induced bronchoconstriction. The review also compares the effects between a short acting beta‐agonist alone to a combination of a short acting beta‐agonist + mast cell stabiliser. Search methods We searched the Cochrane Airways Group Specialised Register, CENTRAL, Current Contents, review articles, textbooks and reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. Searches are current as of August 2008. Selection criteria Randomised trials comparing a single prophylactic dose of a mast cell stabiliser to a short acting beta‐agonist, anti‐cholinergic agent, or a short acting beta‐agonist alone to a combination of short acting beta‐agonist plus a mast cell stabiliser to prevent exercise‐induced bronchoconstriction in asthmatics over six years old. The exercise challenge had to conform to acceptable standards and pulmonary function (PFT) reported as percent decrease from baseline of FEV1 or peak flow. Complete protection (maximum % fall PFT