Exercise-Induced Asthma in Children and Young People

What is Exercise-Induced Asthma?

Exercise-induced asthma (also known as exercise-induced bronchoconstriction or EIB) refers to the narrowing of the airways that happens during or after physical activity. It is a common issue in children and young people with asthma, although it can also occur in those without a formal asthma diagnosis.

EIA causes asthma-like symptoms such as coughing, wheezing, chest tightness, and shortness of breath when a child is active, especially during vigorous exercise or when exposed to cold, dry air.

What Causes Exercise-Induced Asthma?

When a child exercises, they tend to breathe faster, often through their mouth. This bypasses the nose’s natural ability to warm and humidify air. As a result, the lungs are exposed to cooler, drier air that can irritate the airways, leading to bronchoconstriction – the tightening of the muscles surrounding the airways.

Common triggers include:

Cold, dry air (e.g. during outdoor winter sports)
High pollen or pollution levels
Chlorinated swimming pools
Recent respiratory infections
Poorly controlled underlying asthma

What Are the Symptoms?

Children with exercise-induced asthma may experience symptoms during or shortly after exercise. These symptoms usually start within the first 5-10 minutes of activity and can worsen after stopping. Symptoms may last for up to an hour.

Typical symptoms include:

Coughing (often the first and only symptom)
Wheezing
Chest tightness or discomfort
Shortness of breath
Fatigue or poor endurance
Inability to keep up with peers during physical activity

It’s important to differentiate between exercise-induced asthma and simply being unfit or tired after exercise. Children with exercise-induced asthma usually take longer to recover and often describe a sense of chest tightness or difficulty breathing.

How Is Exercise-induced asthma diagnosed?

If your child shows signs of exercise-induced asthma, a doctor will :

Take a detailed history of symptoms, triggers, and family background.
Conduct lung function tests, including spirometry, before and after exercise.
Sometimes, ask the child to exercise (e.g., run outside or use a treadmill), followed by breathing tests to check for airway narrowing.

In some cases, your child may be referred to a specialist in paediatric respiratory medicine for further evaluation.

How Is It Treated?

In the UK, all newborns are screened for cystic fibrosis as part of the newborn blood spot test (heel prick test). If the test suggests CF, further tests are performed:

Reliever Inhalers (Short-acting bronchodilators):
The most common treatment for EIA is using a blue reliever inhaler (e.g. salbutamol) 10–15 minutes before exercise. This helps to open up the airways and prevent symptoms. The effect usually lasts for up to 4 hours.
Preventer (Controller) Inhalers:
If symptoms are frequent or if your child has asthma that isn’t well controlled, a preventer inhaler (such as an inhaled corticosteroid) may be prescribed for regular daily use. Some children may benefit from a combination inhaler (which includes both a preventer and reliever medicine).
Other options:
Montelukast (a leukotriene receptor antagonist) or Atrovent (Ipratropium bromide) may be helpful in some children with exercise-induced asthma.

Managing Exercise-induced asthma and Staying Active

Exercise is important for children’s physical and emotional well-being, including those with exercise-induced asthm. With the right support and management plan, most children can participate in all types of physical activity, including competitive sports.

Tips to help manage Exercise-induced asthma

Pre-treatment: Use the prescribed treatment before exercise.
Warm-up: Encourage a gradual warm-up (e.g. 10–15 minutes of light activity).
Cool-down: After exercise, cool down slowly to avoid sudden airway changes.
Breathe through the nose: Helps warm and humidify the air.
Avoid cold air: Use a scarf or mask over the mouth/nose in cold weather.
Be aware of triggers: Avoid outdoor exercise on days with high pollen or pollution.
Access to medication: Ensure all medications / inhalers are readily available during activities.

Which Activities Are Suitable?

Children with exercise-induced asthma can participate in most activities, especially with good preparation and treatment. Some sports are more likely to trigger symptoms than others.

Higher risk activities:

Long-distance running
Soccer, hockey, basketball
Cold-weather sports (e.g. ice skating, cross-country skiing)

Lower risk activities:

Swimming (especially indoors)
Short-distance sprints or interval-based sports
Walking, cycling at a relaxed pace
Gymnastics, golf, baseball, volleyball

When to Seek Help

You should speak to your child’s respiratory doctor if:

Symptoms occur frequently or interfere with daily life
Medications/inhalers do not seem to work effectively
Your child avoids physical activity due to fear of symptoms

A personalised Action Plan can help guide you on what to do before, during, and after exercise, as well as when to seek urgent care.

With proper diagnosis, regular treatment, and an individualised plan, children with exercise-induced asthma can stay active, healthy, and confident. Many elite athletes live with exercise-induced asthma, and your child can too.

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