Abstract
Exercise-induced bronchospasm (EIB) is a common, often unrecognized and undiagnosed, condition in children. The goal of treatment for EIB is to allow children and adolescents to maintain activity levels similar to those of their peers. Patients who develop symptoms only after strenuous activity can be treated prophylactically and do not require continuous treatment. Whereas short-acting β2-adrenergic receptor agonists (SABAs; e.g., albuterol) can protect against the symptoms of EIB in 80-95% of cases, these agents may not always be a practical treatment option. Results from small, randomized, placebo-controlled, single-dose studies comparing long-acting β2-adrenergic receptor agonists (LABAs) with SABAs in children and/or young adults have demonstrated that occasional dosing with formoterol or salmeterol provides significantly greater protection against EIB for a longer time than do SABAs. The onset of action of formoterol is comparable to that of albuterol (3 minutes), whereas the onset of action of salmeterol is markedly slower. Unlike albuterol, the protective effects of formoterol last more than 12 hours and salmeterol may last up to 12 hours. The results from these studies suggest that LABAs are a viable alternative to SABAs when children need occasional longer-term protection against EIB. Treatment with the LABA formoterol on an as-needed basis provides the advantages of a fast onset of action and a long duration of effect. However, the need for rapid access to rescue medication remains. Clinicians must continue to educate patients, caregivers, and school personnel about this important issue.