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Asthma impacts approximately 300 million people across the lifespan worldwide and contributes to nearly 1,000 deaths per day.1-3 Among the physically active population, appropriate diagnosis and management of asthma is necessary to ensure physical activity at a level comparable to peers.4 Athletes have an increased prevalence of asthma and other respiratory disorders, and asthma can be more challenging to manage in athletes, as compared to the general population.4-5 Specific guidelines for the management of exercise-induced asthma in athletes can help to enhance quality of life and performance. While the NATA has published a position statement related to the recognition, prophylaxis, and management of asthma,6 the Global Initiative for Asthma3 (GINA) has released updated guidelines related to evidence-based asthma management strategies for healthcare providers. The GINA 2025 update emphasizes treating asthma as an inflammatory disease from the very first symptoms.3 In people aged 12 years and older, the primary goal is to reduce the risk of severe attacks by ensuring every dose of a reliever is paired with an anti-inflammatory medication. Short-acting beta2-agonists (SABA) such as albuterol are no longer preferred as the reliever or “rescue” medication for asthma symptoms. Instead, an inhaler containing a combination of a low-dose inhaled corticosteroid (e.g., budesonide) and formoterol, a long-acting beta2-agonist (low-dose ICS-formoterol), is recommended to be used as needed for quick relief of asthma symptoms. Compared to using SABA alone for quick relief of symptoms, low-dose ICS-formoterol is associated with decreased risk of exacerbations and hospitalizations, among other positive outcomes. ICS-formoterol combination inhalers can also be used as needed before exercise for those with exercise-induced asthma.3 In people with infrequent asthma symptoms, controller medications may not be needed.3 For those with more frequent asthma symptoms, the same inhaler containing ICS and formoterol can be used as both a controller medication taken every day and a reliever medication taken as needed. Current asthma guidelines emphasize personalized asthma management to control symptoms, minimize long-term risk, and enhance quality of life. Clinicians are encouraged to review, assess, and adjust asthma care regimens based on individual patient needs. Objective testing including spirometry, bronchoprovocation and exercise challenge tests are essential for optimizing management of asthma especially in athletes6 to differentiate exercise induced bronchospasm in non-asthmatics from asthma exacerbations during exercise in asthmatics.5 The guidelines do allow for SABA-containing reliever medications, if appropriate for an individual patient.3 In summary, there is a need to ensure access to contemporary asthma medications, such as combination inhalers containing a low-dose inhaled corticosteroid and formoterol, a long-acting beta2-agonist3 for those who are physically active. Health professionals should use their professional judgment, consider patient values, and follow national and local regulations when deciding on treatment. |
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There is limited research, therefore, the NATA Foundation encourages research projects in this area. |
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The 2025 GINA Asthma Guidelines reinforce evidence-based recommendations that shift away from SABA-only treatment, but rather emphasize inhaled corticosteroid-containing regimes, particularly those that include ICS-formoteral as both maintenance and reliever. Additional highlights include environmental and climate impacts on asthma care while encouraging shared decision-making among health care providers and patients.
“Improvements in asthma control after pharmacist involvement in an outpatient pediatric asthma clinic.” Anthony et al. 2025
Outpatient pharmacist visits were associated with significant improvements in asthma control, as measured by the asthma control test and childhood asthma control test tools, among 16 children aged 6 -17 years old. “Effects of asthma on the performance of activities of daily living: A retrospective study.” Meys et al. 2025
Individuals with asthma commonly experience activity restrictions in everyday living. Occupational therapy can be integral in assessing and tailoring interventions to improve occupational performance and participation. Athletes, and those that are physically active, should manage their asthma through symptom control, prevention, and reduction of complications. Primary pharmacological treatments include inhaled corticosteroids; short-activing beta antagonists should be used in combination with other medications rather than as stand alone treatments. Non-pharmacological approaches such as trigger avoidance and engaging in a thorough warm-up are also recommended.
“Exercise recommendations and practical considerations for asthma management - An EAACI position paper.” Price et al. 2025
Exercise should be included as a part of each individual’s personalized asthma management plan, considering how to facilitate safe and effective exercise in order to improve individuals’ overall health. “Effects of inhaled β2‐AR agonists in athletes according to the WADA 2025 list: New insights from a systematic review and meta‐analysis.” Calzetta et al. 2026
The evidence supports use of inhaled beta-2 agonists within specified limits as it provides therapeutic bronchodilation for athletes with asthma or exercise induced bronchoconstriction without significant impact on aerobic performance. “Pharmacological advances in managing exercise‐induced bronchospasm: An umbrella review following PRIOR guideline. ” Calzetta et al. 2026 This review confirms the effectiveness of multiple pharmacological treatments to prevent exercise induced bronchospasm. However the authors note a distinction between exercise induced bronchospasm in those without asthma versus exercise induced asthma attack during exercise those with asthma. |
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References in introduction 2. Global Burden of Disease. 2017 Disease, injury incidence, prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990– 2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1789–1858. DOI: 10.1016/S0140-6736(18)32279-7 3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated 15 November 2025. Available from www.ginasthma.org. 5. Ora J, De Marco P, Gabriele M, Cazzola M, Rogliani P. Exercise-induced asthma: Managing respiratory issues in athletes. J Funct Morphol Kinesiol. 2024; 9(15). 6. Miller MG, Weiler JM, Baker R, Collins J, D'Alonzo G. National Athletic Trainers’ Association position statement: management of asthma in athletes. J Athl Train. 2005; 40(3): 224-45. PMID: 16284647; PMCID: PMC1250269. 7. Calzetta, L., Pistocchini, E., Reverberi, E., Gholamalishahi, S., Salvati, A., Manzetti, G. M., Cazzola, M., & Rogliani, P. (2026). Pharmacological advances in managing exercise‐induced bronchospasm: An umbrella review following PRIOR guideline. Scand J Med Sci Sports, 36(1), e70196-n/a. https://doi.org/10.1111/sms.70196 |
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This interprofessional content was developed in part by Sarah Manspeaker (PhD, LAT, ATC, FNAP); Laura Kunkel (EdD, LAT, ATC, FNAP); Amber King (PharmD, BCPS, FNAP); Elizabeth D. DeIuliis (OTD, OTR/L, CLA, FNAP, FAOTA); Kim Clark (EdD, RRT, FAARC, FNAP); Nancy Colletti (PhD, RRT, FNAP); Melissa Snyder (PhD, LAT, ATC, CSCS) and the NATA Foundation Educational Resources Committee. |
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