Exercise-induced Asthma in Children

So-Yeon Lee; Hyo-Bin Kim; Jinho Yu; Soo-Jong Hong

Disclosures

Expert Rev Clin Immunol. 2009;5(2):193-207. 

In This Article

Clinical Manifestations

The clinical presentations of EIA include cough, wheezing, chest tightness, unusual shortness of breath and/or excess mucus after a burst of strenuous and continuous aerobic exercise.[25,26] In most cases, symptoms correlate with the intensity of the exercise. Cough and chest tightness are most suggestive of EIA, although self-reported symptoms do not significantly correlate with the symptoms encountered during a positive exercise challenge. Therefore, EIA diagnoses made on the basis of self-reported symptoms must be confirmed via further objective evaluations. The potential symptoms of EIA are shown in Box 1.

Symptoms of EIA begin approximately 6-8 min after strenuous exercise; however, patients who exercise for longer periods of time may not experience symptoms after exercise. In some cases, patients could recognize asthma symptoms during exercise that continue to increase even after the intensity of exercise was reduced (Figure 1).

Figure 1.

Typical pattern of exercise-induced asthma. Patients often experience improvements in lung function during exercise. Exercise-induced asthma does not fully manifest until after exercise. FEV1 = Forced expiratory volume in 1 s.

Nonspecific symptoms (e.g., poor performance or feeling 'out of shape,' abdominal pain, headache, muscle cramps, fatigue and dizziness) may be suggestive of EIA (Box 1).[27] In otherwise healthy children and adolescents, chest pain may indicate EIA.[28] Other, more-subtle symptoms include prolonged upper respiratory illness, 'locker-room cough', difficulty in sleeping owing to nocturnal symptoms, heavy legs, seasonal fluctuations in asthma and asthma-like symptoms, particularly those related to humidity, pollen content or levels of airborne pollutants, avoidance of activity and an inability to keep up with peers.[29] These symptoms can worsen after exposure to certain triggers during exercise, such as animal dander, house dust mites, mold, cigarette smoke, pollen, pollution, airborne chemicals or changes in weather.[30,31,32]

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