Up to 80% of kids with asthma have symptoms when they exercise. It makes sense that cigarette smoke and pollen could trigger asthma symptoms, but why exercise?

Cold, dry air that's inhaled during exercise is believed to be the main cause of these symptoms. When kids exercise or play strenuously, they tend to breathe quickly, shallowly, and through the mouth. So the air reaching their lungs misses the warming and humidifying effects that happen when they breathe more slowly through the nose.

The cool, dry air causes the airways in the lungs to become narrower, which blocks the flow of air and makes it harder to breathe. This narrowing, called bronchoconstriction, occurs in up to 20% of people who don't have asthma, which is why it's sometimes referred to as "exercise-induced bronchoconstriction (EIB)" rather than "exercise-induced asthma (EIA)."

Symptoms

Symptoms of exercise-induced asthma include wheezing, tightness or pain in the chest, coughing, and in some cases, prolonged shortness of breath. Some symptoms are more noticeable than others, which means exercise-induced asthma can sometimes go undiagnosed.

Someone may have exercise-induced asthma if he or she:

• gets winded or tired easily during or after exercise
• coughs after coming inside from being active outdoors
• can't run for more than a few minutes without stopping

Kids with exercise-induced asthma often begin having symptoms 5 to 10 minutes after starting to exercise. Symptoms usually peak 5 to 10 minutes after stopping the activity and may take an hour or longer to end. Some people with EIA even have symptoms for hours after exercise. Although symptoms often appear while kids are active, sometimes they can appear only after the activity has stopped.

Of course, there's a difference between someone with exercise-induced asthma and someone who's out of shape and is simply winded. Out-of-shape people can catch their breath within minutes, whereas it takes much longer for someone with EIA to recover. And extremes of temperature, especially cold weather, can make it even worse.

Diagnosing EIA

A doctor who suspects exercise-induced asthma will ask about the family's asthma and allergy history and about the symptoms and what has triggered them in the past.

After taking a detailed history and performing a physical exam, the doctor may ask your child to perform a breathing test after exercising. This can be done in the office on a treadmill, after your child has run outside for 6 to 8 minutes, or after participating in whatever activity has triggered flare-ups in the past.

Treating EIA

Doctors sometimes recommend pretreatment, which means taking medication before exercise or strenuous activity, for kids with exercise-induced asthma. This medication is often the same fast-acting, short-term medication used during flare-ups, known as rescue medication, although in this case its function is preventative. By taking this medication before exercise, the airway narrowing triggered by exercise can be prevented.

If pretreatment isn't enough to control symptoms, the doctor may recommend that someone also use controller medication, which is usually taken regularly over time to reduce airway inflammation.

If, despite medication, your child still has breathing trouble during exercise, let the doctor know. The medication dosages may need to be adjusted for better control. Also, contact the doctor if there are any changes with your child's breathing problems.

Recommended Activities for Kids With EIA

Exercise is a great idea for everyone, including kids with exercise-induced asthma. Try to encourage your child to be active while also keeping asthma symptoms under control by following the doctor's instructions.

In addition to keeping kids fit, exercise can improve lung function by strengthening the breathing muscles in the chest. Ask your doctor about exercise and what kinds of precautions your child should take.

Of course, some sports are less likely to cause problems for kids with exercise-induced asthma, such as:

• walking
• jogging
• hiking
• golf
• baseball
• football
• gymnastics
• shorter track and field events

Endurance sports (like long-distance running and cycling) and those requiring extended energy output (like soccer and basketball) may be more challenging, as can cold-weather endurance sports like cross-country skiing or ice hockey.

But that doesn't mean your child can't participate in these sports if he or she truly enjoys them. In fact, many athletes with asthma have found that with proper training and medication, they can participate in any sport they choose.

Tips for Kids With Exercise-Induced Asthma

For the most part, kids with exercise-induced asthma can do anything their peers can do. But be sure to follow the suggestions given by your child's doctor.

Here are some of the tips often recommended:

• Warm up before exercise to prevent chest tightening. (Warm-up exercises can include 5 to 10 minutes of walking or any other light activity, in addition to stretching or flexibility exercises.)
• Take rescue medication as close to the start of exercise as possible.
• Breathe through the nose during exercise.
• Take brief rests during exercise and use rescue medication, as prescribed, if symptoms start.
• Cool down after exercise to help slow the change of air temperature in the lungs.

In addition, someone experiencing symptoms shouldn't start exercising until the symptoms stop.

It's also wise for kids with EIA to avoid exercising outside during very cold weather. If your child will be playing outside when it's cold, wearing a ski mask or a scarf over the mouth and nose should help.

If air pollution or pollen also trigger asthma symptoms, your child may want to exercise indoors when air quality is poor or pollen counts are high. And exercise should be avoided during any upper respiratory infection.

You can help by ensuring your child takes all medicine prescribed by the doctor, even on days when he or she feels fine. Skipping controller medication can make symptoms worse and forgetting to take rescue medication before exercise can lead to severe flare-ups and even emergency department visits.

Kids should always have access to their rescue medication. Keep extras on hand and be sure to regularly check all supplies so your child isn't carrying around an empty inhaler.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2010