Novel understanding in diagnosis and management of exercise-induced bronchoconstriction.

Abstract

Introduction: Exercise-induced bronchoconstriction (EIB) is a common cause of exercise-related respiratory symptoms in athletes and is traditionally diagnosed by demonstrating airway narrowing following exercise or surrogate bronchoprovocation testing. Whilst this provides objective evidence of bronchoconstriction, it offers limited insight into the underlying pathophysiology of airway dysfunction.

Areas covered: This review discusses emerging developments in EIB, focusing on biomarkers of airway inflammation and injury, respiratory oscillometry, breathing pattern assessment and wearable respiratory monitoring. The concept that EIB may represent the clinical manifestation of a broader process of airway injury and remodeling is also considered. Relevant literature was identified through searches of PubMed and Google Scholar with no lower date restriction to May 2026, supplemented by reference-list searching.

Expert opinion: The future challenge in EIB is no longer simply confirming bronchoconstriction but identifying athletes at risk of airway dysfunction before clinically significant disease develops. Emerging biomarkers, oscillometry and continuous respiratory monitoring may enable earlier phenotyping and more personalized management than conventional bronchoprovocation testing alone. Collectively, these approaches have the potential to shift EIB care from diagnosing established disease toward preserving airway health within a holistic model of athlete respiratory care.