Exercise-Induced Bronchoconstriction in Children and Adolescents

Abstract

Exercise-induced bronchoconstriction (EIB) is common in children. This article reviews the epidemiology, clinical presentation, pathophysiology, diagnosis, and treatment of EIB. EIB is caused by transient narrowing of the airways during or most often after exercise and indicates airway hyperresponsiveness. EIB is an important cause of exercise limitation in children. However, the diagnosis of EIB can be challenging because symptoms poorly predict the presence of EIB. Bronchial challenges, such as cardiopulmonary exercise testing, are required to document EIB. The severity of EIB is worsened by exposure to inhalational toxicants such as chlorine in pools and air pollution. In most children, EIB can be effectively prevented by both nonpharmacological means and medications. Educating the child, his/her family, and supervising adults about asthma triggers and management is important. Prompt recognition and treatment of an asthma attack associated with exercise is critical; bronchodilators should be on the sidelines at all times, and an asthma action plan should be in place.T he benefits of exercise are well known. Exercise improves conditioning, self-esteem, 1 and academic performance 2,3 and reduces cardiovascular disease and obesity. 4,5 In asthmatic individuals, exercise improves cardiopulmonary performance, fitness, breathlessness, and quality of life and decreases the need for asthma maintenance medications. 6,7 However, exercise is an important trigger for asthma attacks; it can cause bronchoconstriction. Exercise-induced bronchoconstriction (EIB) is caused by transient narrowing of the airways during or most often after exercise and indicates airway hyperresponsiveness. 8-11 EIB can be severe and can cause respiratory arrest and death. 12 EIB can be effectively treated and prevented. Therefore, it is extremely important to recognize the signs and symptoms of EIB.This review is aimed toward delineating the epidemiology, clinical presentation, pathophysiology, diagnosis, and treatment of EIB in children and adolescents. EIB is an important cause of exercise limitation in children. Children are particularly at risk for EIB because they have higher rates of asthma than adults. 13 In addition, children are more active; approximately 30 million children and adolescents in the United States participate in organized sports. 14 The higher activity levels and relatively immature lungs of children may make them more susceptible to inhalational toxicants, such as air pollutants, which worsen EIB. 15-17 EIB in children can be effectively treated, and it is, therefore, important to recognize its signs and make an accurate diagnosis. However, in organized sports, children with asthma are often left in the care of coaches or supervising parents that have inadequate knowledge of their disease management. 18 Asthma education plays an important role in ensuring the optimal performance and safety of children with EIB. Epidemiology EIB occurs in 10% to 15% of children. 19,20 In children with persistent asthma, the prevalence of E...

Evaluation and Characterization of Environmental Risks and Asthma Management Knowledge and Awareness Through Surveys of Coaches, Athlete Parents/Guardians, and Athletes

“…The environmental health concern choices of parents/guardians of asthmatic athletes suggested they may benefit from education aimed at improving asthma trigger awareness and increasing the effectiveness of approaches they are already using. 55,56 This study indicates coaches and college athletes may be more likely to perceive fears of looking weak or out of shape as barriers to proper asthma management practices during sports participation. Parents/guardians of athletes may be more concerned about a lack of proper access to medical care for asthmatic athletes.…”

“…The environmental health concern choices of parents/guardians of asthmatic athletes suggested they may benefit from education aimed at improving asthma trigger awareness and increasing the effectiveness of approaches they are already using. 55,56…”

Irritants, Irritancy and Irritant Induced Asthma

“…Exercising speed and power athletes may increase their ventilation rate as much as 200 liters per minute for short periods of time [213]. The mechanism to explain exercise-induced bronchospasm suggests that hyperventilation leads either to airway cooling with airway water loss and/or, in some manner, changes the osmolality of periciliary fluid lining evoking mucosal release of endogenous mediators causing airway smooth muscle contraction [214,215]. Being in a cold (and relatively dry) mountain environment produces more rapid respiratory water vapor loss as the exercise ventilatory rate increases.…”