Up to 90% of kids with asthma have symptoms when they exercise. It makes sense that cigarette smoke and pollen could trigger asthma symptoms, but why exercise?

The cold, dry air that's inhaled into the lungs during exercise is believed to be the main cause of exercise-induced asthma, or EIA. When your child exercises or plays strenuously, he or she tends to breathe quickly, shallowly, and through the mouth. This means that the air reaching the lungs has missed the warming and humidifying effects that happen when your child breathes more slowly through the nose.

If your child has exercise-induced asthma, his or her lungs are overly sensitive to this sudden change in temperature and humidity. The airways become irritated and this triggers asthma symptoms. Variations in the amount of sensitivity mean that the severity of symptoms is different from person to person.

What Are the 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.

A child may have exercise-induced asthma if he or she:

• feels winded or tired easily during or after exercise
• coughs when he or she comes inside from playing outdoors
• can't run for more than a few minutes without stopping

Children with exercise-induced asthma often begin experiencing symptoms 5 to 10 minutes after they start exercising. Symptoms usually peak 5 to 10 minutes after stopping the activity and may take an hour or longer to subside. Some people with exercise-induced asthma even have symptoms for hours after exercise. Although symptoms often appear while the child is 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. An out-of-shape person can catch his or her breath within minutes, whereas it takes much longer for the person with exercise-induced asthma to recover. And extremes of temperature, especially cold weather, can make exercise-induced asthma even worse.

How Is It Diagnosed?

If your child's doctor suspects exercise-induced asthma, he or she may ask a lot of questions about the family's asthma and allergy history and about your child's symptoms and what has triggered them in the past.

After the doctor takes a detailed history and performs a physical exam, he or she 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.

How Is It Treated?

If your child has exercise-induced asthma, the doctor may recommend pretreatment, which means taking medication before exercise or strenuous activity. 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 your child 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, see your child's doctor. Your child's medication dosages may need to be adjusted for better control. Also, let your child's doctor know of any changes in your child's breathing trouble.

Recommended Activities for Kids With Exercise-Induced Asthma

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

In addition to keeping your child fit and keeping his or her weight healthy, exercise can improve lung function by strengthening the breathing muscles in the chest. Ask your child's doctor about exercise and what kinds of precautions your child should take.

Of course, there are some sports that are less likely to cause problems for children with exercise-induced asthma:

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

Endurance sports, like long-distance running and cycling and those that require extended energy output, like soccer and basketball, may be more challenging for children with exercise-induced asthma. This is especially true for 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, children 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, if your child is experiencing symptoms, he or she shouldn't start exercising until the symptoms subside.

It's also a good idea for children with exercise-induced asthma 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 your child's asthma symptoms, he or she may want to exercise indoors when air quality is poor or pollen counts are high. And your child should avoid exercise when he or she has an 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.

Make sure your child always has access to his or her rescue medication. Also, have extras on hand and be sure to check your child's supplies so that he or she isn't carrying around an empty inhaler.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: June 2007