Date:
Patient:
MRN:
Clinician: (Pulmonologist, Sports Medicine Physician, Primary Care Physician)
Reason for Visit:
Evaluation for symptoms suggestive of EIB (cough, wheeze, chest tightness) during or after exercise
Follow-up for diagnosed EIB
Medication adjustment or management of exercise strategies
History of Present Illness:
Briefly describe the patient’s symptoms:
Onset, duration, and severity of cough, wheeze, or chest tightness in relation to exercise (during, immediately after, or delayed)
Triggers (specific type of exercise, cold weather, etc.)
Impact on exercise performance and quality of life
Past Medical History:
Include any relevant past medical conditions, such as:
Asthma (diagnosed or suspected)
Allergic rhinitis
Sinusitis
Vocal cord dysfunction (VCD) (can mimic EIB)
Social History:
Smoking history (current and past)
Exposure to environmental irritants (occupational or home)
Family History:
History of asthma or allergies in first-degree relatives
Physical Exam:
General: Appearance of respiratory distress at rest or after exercise provocation testing (if performed)
Vital Signs: Temperature, pulse, oxygen saturation (may decrease with EIB)
Lung exam: Wheezing on auscultation (may not be present in all cases)
Labs:
Spirometry with bronchodilator reversibility testing (considered the gold standard for EIB diagnosis, although not always performed)
Pre-bronchodilator FEV1/FVC ratio may be lower in patients with EIB.
Significant improvement in FEV1 after bronchodilator inhalation suggests EIB.
Consider mentioning other tests performed to rule out other diagnoses, such as complete blood count (CBC) or allergy testing.
Imaging:
Chest X-ray is not typically needed for EIB diagnosis but may be performed to rule out other lung conditions.
Assessment:
Diagnose EIB based on clinical presentation, history of exercise-related symptoms, and objective testing results (if available).
Assess the severity of EIB based on symptom frequency, impact on exercise, and spirometry findings.
Plan:
Outline the treatment plan based on severity:
Non-pharmacologic:
Warm-up before exercise
Cool-down after exercise
Identify and avoid triggers (cold weather, specific exercises)
Pharmacologic:
Short-acting bronchodilator inhaler (e.g., albuterol) used before exercise to prevent symptoms
Consider inhaled corticosteroids (ICS) for more frequent or severe EIB (consult with a specialist)
Consider referral to a pulmonologist or sports medicine physician for further evaluation and management.
Prognosis:
Briefly discuss the prognosis, which is generally good with proper management. Exercise can often be continued with appropriate strategies.
Education:
Document any education provided to the patient regarding:
Symptoms and triggers of EIB
Importance of warm-up and cool-down routines
Proper use of inhalers (if prescribed)
Strategies to maintain physical activity despite EIB
Notes:
Include any additional relevant information not covered above, such as the patient’s motivation for exercise and adherence to recommendations.
Disclaimer: This is a template and should be adapted to the specific needs of each patient.