Bronchoconstriction is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath. Causes The condition has a number of causes, the most common being emphysema as well as asthma. Exercise and allergies can bring on the symptoms in an otherwise asymptomatic individual. Emphysema With emphysema the shortness of breath due to effective bronchoconstriction from excessive very thick mucus blockage (it is so thick that great difficulty is encountered in expelling it resulting in near exhaustion at times) can bring on panic attacks unless the individual expects this and has effectively learned pursed lip breathing to more quickly transfer oxygen to the blood via the damaged alveoli resulting from the disease. The most common cause of emphysema is smoking and smoking cessation is mandatory if this incurable disease is to be treated. Prevention of bronchoconstriction by this pathway is vital for people with emphysema and there are several anticholinergic medications that in combination with mucous thinning agents such as Guaifenesin cause significant improvement in breathing. Exercise-induced bronchoconstriction More generally termed exercise-induced asthma, the preferred and more accurate term exercise-induced bronchoconstriction better reflects underlying pathophysiology. It is also preferred due to the former term giving the false impression that asthma is caused by exercise. In a patient with EIB, exercise initially follows the normal patterns of bronchodilation. However, by three minutes, the constriction sets in, which peaks at around 10–15 minutes, and usually resolves itself by an hour. During an episode of this type of bronchoconstriction, the levels of inflammatory mediators, particularly leukotrienes, histamine, and interleukin, increase. TH2-type lymphocytes are activated, with an increase in T cells expressing CD25 (IL-2R), and B cells expressing CD 23, causing increased production of IgE. After exercise, the conditions will fade within one to three minutes. In most people with EIB, this is followed by a refractory period, of generally less than four hours, during which if exercise is repeated, the bronchoconstriction is less emphasised. This is probably caused by the release of prostaglandins. The underlying cause of this type of bronchoconstriction appear to be the large volume of cool, dry air inhaled during strenuous exercise. The condition appears to improve when the air inhaled is more fully humidified and closer to body temperature. This specific condition, in the general population, can vary between 7 and 20 percent. This increases to around