Exercise is one of the most common triggers of exercise-induced bronchospasm (EIB), with less trained athletes showing more symptoms. Exercise-induced bronchospasm is a common and frequent problem among elite athletes with obvious implications on competing performance, health, and quality of life. Classical pathways in the development of EIB in this population include the osmotic and the thermal theory as well as the presence of epithelial injury and inflammation in the airway. Moreover, neuronic stimulation has been suggested as a potential modulator of EIB in elite athletes. In this category of population, the diagnosis of EIB is a serious challenge, especially as spirometry before and after bronchodilation is not diagnostic and specific tests are required. To date, there is no organized screening in asymptomatic elite athletes to detect EIB. This review aims to summarize the pathophysiology, clinical manipulations, and therapeutic approach of EIB in elite athletes. We searched for published studies related to the aim of this study. Exercise-induced bronchospasm is a serious and common disorder in elite athletes, and its symptoms are nonspecific with a need to confirm the diagnosis with specific tests.