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 Yale-New Haven Hospital, New Haven, Connecticut, USA HealthLINK: Pediatrics
November 23, 1999

News this month
Exercise-induced asthma

Exercise-induced asthma (EIA) is commonly missed in children and young adults and should be ruled out in children who have breathing-related difficulties following exercise, say two leading pediatric pulmonologists. But even if children have EIA, proper treatment can help them lead active, healthy lives.

EIA often presents with the characteristic wheezing, shortness of breath and chest tightness associated with chronic asthma

In the September online edition of Pediatrics, Henry Milgrom, MD, and Lynn M. Taussig, MD, of the National Jewish Medical and Research Center, reviewed past studies and current treatment regimens to offer readers clues as to why EIA is so often overlooked and how best to treat it. The complete article is available online by following a link at the bottom of this page.

What is EIA?
All types of asthma are characterized by inflammation and constriction of the small air passageways of the lungs. This bronchoconstriction happens in response to one or more triggers, including pollen, air quality, respiratory infections, wood burning stoves, humidity, cold air and, in this case, exercise. Airway obstruction brought on by exercise is termed EIA. EIA tends to show up in children more often because, frankly, children are usually more active than adults.

Some children with EIA characteristically cough or wheeze and become short of breath while exercising. For other children, symptoms begin 10 to 15 minutes after they stop exercise. In either case, these children would be diagnosed with exercise-induced asthma.

EIA frequently goes undiagnosed in part because EIA can resolve on its own once exercise has stopped, the researchers noted. EIA frequently occurs in up to 90 percent of children with chronic asthma, but is also found in about 9 percent of children who have no history of asthma or allergies, they reported.

It is important to recognize the difference between a child who is not in good physical condition (out of shape) and exercise-induced asthma. As the review in Pediatrics pointed out, in well-conditioned athletes, symptoms of exercise- induced asthma only occur with the most vigorous activity or exercise.

In one study of high school athletes, 12 percent tested positive for EIA, even though they were not considered at risk for the condition.

The Olympic challenge
The researchers cited past studies that demonstrated just how easy it was to miss a diagnosis of EIA. In one study of high school athletes, 12 percent tested positive for EIA, even though they were not considered at risk for the condition. Of the 595 members of the 1984 U.S. Olympic team, precompetition screening found that 67 had EIA, while only 26 had been previously identified. Because of this, the authors urged screening for EIA "even in well-conditioned individuals who appear to be in excellent health" if any history of exercise-related breathing difficulties is present.

Even if a proper diagnosis is made, poor disease management can compound the problem. Appropriate therapy can allow most children with EIA to control symptoms and participate in any vigorous activity, the authors wrote. Staying fit has the added bonus of reducing the chances of an asthma attack by helping the body work more efficiently, thus reducing the amount of air needed.

Appropriate therapy can allow most children with EIA to control symptoms and participate in any vigorous activity.

Long v. short-acting medications
The researchers outlined several medications that are effective against EIA, including short-acting beta-agonists, longer-acting bronchodilators and finally anti-inflammatory agents. Longer acting agents may be easier for children to use because they can be taken at home and are helpful if children engage in spontaneous activities, as children are apt to do.

Helping children fulfill their potential
Early diagnosis coupled with long-acting treatment regimens “should help these young people enjoy the benefits of an active lifestyle and fulfill their athletic potential.



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Request an appointment
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to talk with a referral coordinator.

Alia Bozzy-Asaad, M.D.

Understanding exercise-induced asthma

In the Pediatric Asthma Clinic at Yale-New Haven Children’s Hospital, we see a fair number of children with EIA. When undiagnosed, EIA can be an obstacle to an active lifestyle. But when the disease is identified and well managed, the results can be remarkable.

“…symptoms may be less clear, such as a cough that won't go away.”

How is EIA diagnosed?
EIA tends to show up at about the time children start school and become more active. Sometimes, a diagnosis of EIA is easy to make, but more often symptoms may be less clear, such as a cough that won’t go away. We encourage parents to bring these children in for a thorough evaluation.

Role of family history
When diagnosing EIA, we take into account a child’s medical history, details regarding the environment they live and exercise in, their family history of asthma and allergies, as well as a physical examination and results from lung function testing. Taking a family history is especially important in children younger than six for whom a lung function test cannot be used. When a strong family history is present, particularly if one or more immediate member of the family has asthma, there is increased likelihood a child will have asthma. If the child is old enough, we’ll also ask how the child feels after exercising.

At the Yale Pediatric Asthma Clinic, a pediatric pulmonologist and an allergist see children, since allergens are frequently a cause of asthma. In addition to the pulmonary function test, we can also perform exercise challenge testing to determine if it’s asthma that is causing the shortness of breath.

“...we believe helping parents understand their child’s condition is an extremely important part in treating the child.”

Education key to good management
If a child has asthma, whether EIA or chronic asthma, there are a number of steps to be taken. First, we believe helping parents understand their child’s condition is an extremely important part in treating the child and we spend a great deal of time educating families. They need to understand we can’t cure the asthma, but it can be controlled. We make a plan for asthma management and as part of the plan we ask families to keep a journal of what triggers an asthma attack. We also explain the medications, when they should be used and as children get older, we help them take a more active role in managing their asthma.

Using a peak flow meter
Because it’s sometimes difficult for a child, parent, teacher or coach to recognize how a child is feeling, a peak flow meter can be very helpful in monitoring EIA. To use one, the child simply breathes into the portable hand-held device and it registers a number, signifying how much air can be blown out of the lungs. If airways are beginning to narrow, the peak flow number drops and the child knows either to take a rest and/or take more medicine. This can help eliminate some of the confusion that surrounds asthma.

Which sports are best?
Children with asthma still need exercise for their own physical and mental well being. With proper medical management, including pre-treatment before exercise, a good warm-up and cool-down time and close monitoring, a child with EIA can enjoy any activity. Still, some parents may wish to be selective in the type of activity their child participates in, and can discuss this with their physician.

Activity followed by brief rest periods can allow the child to regain control of his or her breathing. Baseball, softball, volleyball, tennis, downhill skiing, golf and some track and field events all have intermittent rest periods. Even strenuous sports like swimming, cycling, distance running and soccer also can be enjoyed by children with EIA. Our Olympic athletes with EIA have proven that.

Dr. Bazzy-Asaad is an attending pediatric pulmonologist at Yale-New Haven Hospital and an associate professor of pediatrics in respiratory medicine at Yale University School of Medicine.



Pediatric Asthma Clinic

If your child has been diagnosed with asthma and you would like to have him or her assessed by a Yale pediatric pulmonologist, call (203) 785-4081 for an appointment.

The clinic meets in the Pediatric Specialty Center of Yale-New Haven Children's Hospital.


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All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.