Paeds · respiratory-sleep-and-airway
Exercise-induced bronchoconstriction
Also known as Exercise-induced bronchoconstriction · Exercise-induced asthma · Exercise-induced bronchospasm · EIB in children · Sport-related wheeze
Fellowship guide to exercise-induced bronchoconstriction in children: the transient airway narrowing that follows a burst of exercise, why it usually signals inadequate asthma control, how it is confirmed objectively with an exercise or eucapnic voluntary hyperpnoea challenge and a ten-percent fall in FEV1, the osmotic and thermal mechanisms that drive it, the mimics that catch the unwary — above all inducible laryngeal obstruction — and the management that keeps a child fully in sport, built on controlling the underlying asthma, a warm-up, and a pre-exercise reliever.
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Red flags
- A child whose breathlessness comes on at peak exertion with inspiratory stridor and throat tightness, and clears within minutes of stopping without a bronchodilator, has inducible laryngeal obstruction (vocal cord dysfunction), not exercise-induced bronchoconstriction — do not escalate asthma therapy for it
- Exercise symptoms that persist despite a correctly used pre-exercise reliever and a good warm-up almost always mean the underlying asthma is poorly controlled — step up the controller and check adherence and inhaler technique rather than simply adding more reliever
- Daily reliance on a short-acting beta-agonist to get through sport produces tolerance and reduced bronchoprotection, and marks a child at higher risk — it is a signal to treat the inflammation, not to prescribe more reliever
- Exertional chest pain, syncope or palpitations, or breathlessness that is out of proportion to a normal spirometry and challenge test, point away from the airway toward a cardiac cause or dysfunctional breathing and demand a different workup
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- Exercise-induced bronchoconstriction
- Exercise-induced bronchoconstriction in children: diagnosis, mechanism and management
- Exercise-induced bronchoconstriction: objective confirmation and the return-to-sport plan
- Short case: the child who wheezes with sport
- Long case: the adolescent athlete with exertional breathlessness and poor asthma control
- Exercise-induced bronchoconstriction in children: diagnosis and management
- Respiratory: the child with exertional wheeze
- Pulmonology: exercise-induced bronchoconstriction
- Patient Care: exercise-induced bronchoconstriction in children
- Medical Expert: exercise-induced bronchoconstriction
Overview & Definition
A child sprints across the playground, and a few minutes later — often just as they stop — the cough starts, the chest tightens, and a wheeze appears that eases again with rest. That sequence is exercise-induced bronchoconstriction: a transient narrowing of the lower airways provoked by a burst of vigorous exercise, coming on during or shortly after the effort, peaking five to fifteen minutes after it ends, and resolving spontaneously within thirty to sixty minutes. It is the airway, not the heart or the legs, that limits the child, and the whole clinical task is to prove that, treat the airway, and get the child back to full sport. [3] [5]
The term names a physiological event, not a disease of its own. Most children who bronchoconstrict with exercise have asthma, and their exercise symptoms are simply the most exertion-sensitive expression of the same twitchy, inflamed airway; in a smaller group — some athletes and otherwise well children — the narrowing occurs without any other features of asthma, and is called isolated exercise-induced bronchoconstriction. Holding this distinction in mind matters, because in the child with asthma the exercise symptoms are usually a marker that the underlying disease is under-treated. [3] [4]
References12ShowHide
- [1]McFadden ER Jr; Gilbert IA Exercise-induced asthma. N Engl J Med, 1994.PMID 8152449
- [2]Anderson SD; Daviskas E The mechanism of exercise-induced asthma is ... J Allergy Clin Immunol, 2000.PMID 10984363
- [3]Parsons JP; Hallstrand TS; Mastronarde JG; Kaminsky DA; Rundell KW; Hull JH; et al An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med, 2013.PMID 23634861
- [4]Weiler JM; Anderson SD; Randolph C; Bonini S; Craig TJ; Pearlman DS; et al Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol, 2010.PMID 21167465
- [5]Weiler JM; Brannan JD; Randolph CC; Hallstrand TS; Parsons J; Silvers W; et al Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol, 2016.PMID 27665489
- [6]Rundell KW; Slee JB Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes. J Allergy Clin Immunol, 2008.PMID 18678339
- [7]Rundell KW; Anderson SD; Spiering BA; Judelson DA Field exercise vs laboratory eucapnic voluntary hyperventilation to identify airway hyperresponsiveness in elite cold weather athletes. Chest, 2004.PMID 15006949
- [8]Boulet LP; O'Byrne PM Asthma and exercise-induced bronchoconstriction in athletes. N Engl J Med, 2015.PMID 25671256
- [9]Price OJ; Hull JH; Backer V; Hostrup M; Ansley L The impact of exercise-induced bronchoconstriction on athletic performance: a systematic review. Sports Med, 2014.PMID 25129699
- [10]Hallstrand TS; Leuppi JD; Joos G; Hall GL; Carlsen KH; Kaminsky DA; et al ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing. Eur Respir J, 2018.PMID 30361249
- [11]Kippelen P; Anderson SD; Hallstrand TS Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction. Immunol Allergy Clin North Am, 2018.PMID 29631728
- [12]Levy ML; Bacharier LB; Bateman E; Boulet LP; Brightling C; Buhl R; et al Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med, 2023.PMID 36754956