Exercise-induced bronchoconstriction (EIB) describes the acute airway narrowing which occurs as a result of exercise. EIB commonly affects individuals with and without clinically recognized asthma, especially those who participate in competitive athletics. EIB is believed to be caused by the loss of water from the lower airways which is the result of heating and humidifying large volumes of air in a short period. The aforementioned procedure results in a hyperosmolar environment which activates various cellular mechanisms to release inflammatory mediators which in turn lead to airway smooth muscle contraction and bronchoconstriction. In elite athletes EIB may also develop from a process of airway injury and changes in the contractile properties of airway smooth muscle. Short acting β2-agonists are recommended first-line agents for pharmacologic treatment, although leukotriene receptor antagonists or inhaled corticosteroids with or without long-acting β2-agonists may be needed in refractory cases. If symptoms persist despite treatment, alternative diagnoses should be considered. In this review we summarize the pathophysiology, the clinical manifestations, the diagnostic approach and the treatment strategies of EIB.