Clinical Commentary Review Improving Screening and Diagnosis of Exercise-Induced Bronchoconstriction: A Call to Action John M. Weiler, MD, MBA a , Teal S. Hallstrand, MD, MPH b , Jonathan P. Parsons, MD, MSc c , Christopher Randolph, MD d , William S. Silvers, MD e , William W. Storms, MD f , and Amy Bronstone, PhD g Iowa City, Iowa; Seattle, Wash; Columbus, Ohio; New Haven, Conn; Englewood and Colorado Springs, Colo; and Moss Beach, Calif This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis of exercise- induced bronchoconstriction (EIB), a transient airway narrowing that occurs during and most often after exercise in people with and without underlying asthma. EIB is both commonly underdiagnosed and overdiagnosed. EIB underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Routine use of a reliable and valid self-administered EIB screening questionnaire by professionals best positioned to screen large numbers of people could substantially improve the detection of EIB. The authors conducted a systematic review of the literature that evaluated the accuracy of EIB screening questionnaires that might be adopted for widespread EIB screening in the general population. Results of this review indicated that no existing EIB screening questionnaire had adequate sensitivity and specificity for this purpose. The authors present a call to action to develop a new EIB screening questionnaire, and discuss the rigorous qualitative and quantitative research necessary to develop and validate such an instrument, including key methodological pitfalls that must be avoided. Ó 2014 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2014;2:275-80) Key words: Exercise-induced bronchoconstriction; Asthma; Screening; Diagnosis; Questionnaire: Accuracy; Validity Exercise-induced bronchoconstriction (EIB) is a common clinical problem in persons with asthma and also occurs in some people who lack other features of asthma. Despite evidence-based clinical practice guidelines for the diagnosis and management of EIB, 1,2 physicians frequently underdiagnose and overdiagnose EIB, which suggests that many physicians are not adhering to these recommendations. Physicians’ poor performance in diag- nosing EIB may be due to a number of issues, including a lack of awareness of the prevalence and burden of this condition, the absence of an effective screening questionnaire to help detect EIB, and inadequate knowledge about how to further evaluate and treat patients with suspected EIB. In November 2012, an expert panel composed of 6 nationally recognized allergists and pulmonologists met to discuss unmet needs regarding the detection of EIB in the general population. (Teva Pharmaceuticals sponsored the meeting but had no role in the development of this article.) This article summarizes the panel’s findings, and constitutes a call to action to improve widespread screening for EIB and appropriate follow-up for individuals with positive screening results. PREVALENCE AND BURDEN OF EIB EIB is an acute bronchoconstriction triggered by exercise, which may occur in the presence of established asthma or in the absence of other features of chronic asthma. 1,2 Common symptoms of EIB include shortness of breath, wheezing, cough, and chest tightness during or immediately after exercise. 1,2 More subtle symptoms that may be suggestive of EIB include fatigue, feeling out of shape, feeling unable to keep up with peers, symptoms that occur repeatedly in specific environments (such as pools, ice rinks, or freshly mowed fields), performances that fall a Department of Internal Medicine, University of Iowa, Iowa City, Iowa b Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Wash c Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, The Ohio State University Medical Center, Columbus, Ohio d Department of Pediatrics, Division of Allergy and Clinical Immunology, Yale University, New Haven, Conn e Allergy Asthma Colorado, P.C., Englewood, Colo f The William Storms Allergy Clinic, Colorado Springs, Colo g BioMedEcon, LLC, Moss Beach, Calif Teva Pharmaceuticals sponsored the expert panel meeting, which led to this article, but had no role in the development of this article. Conflicts of interest: T. S. Hallstrand has received consultancy fees from Teva and Amgen; has received research support from the National Institutes of Health and Amgen; and has received lecture fees from Merck Schering Plough. J. P. Parsons has received consulting fees and travel support from Teva. C. Randolph has received consulting fees, travel support, payment for development of educational presentations from Teva; is on the American College of Allergy, Asthma & Immunology Board; has received lecture fees from AstraZeneca, Teva, Merck, GlaxoSmithKline, and Genentech; is a speaker for Med and Mylan; and is on the Teva Advisory Board. W. S. Silvers has received travel support and lecture fees from Teva. W. W. Storms has received consultancy and speaker’s fees from Alcon, AstraZeneca, Bausch and Lomb, Merck; has received research support and consultancy fees from Amgen; has received research support and speaker’s fees from Genentech/Novartis; has received research support from GlaxoSmithKline and Meda; has received research support, consultancy fees, and speaker’s fees from Ista, Sunovion, and Teva; and has received consultancy fees from Strategic Pharmaceutical Advisors, and TREAT Foundation. J. M. Weiler has received consultancy fees and travel support from Teva and is employed by and owns stock/stock options in CompleWare Corporation. A. Bronstone is employed by BioMedEcon, LLC, which has received consultancy fees from Teva. Received for publication September 26, 2013; revised November 12, 2013; accepted for publication November 14, 2013. Available online February 4, 2014. Corresponding author: John M. Weiler, MD, MBA, Department of Internal Medi- cine, University of Iowa, PO Box 3090, Iowa City, IA 52244. E-mail: jweiler@ compleware.com. 2213-2198/$36.00 Ó 2014 American Academy of Allergy, Asthma & Immunology http://dx.doi.org/10.1016/j.jaip.2013.11.001 275