• Exercise is an essential activity for kids, even for those with asthma.
• Taking long-term controller medication daily (if needed) and short-acting medication before physical activity can make it less likely that exercise will trigger asthma.
• Teaching your child how to warm up before exercise and what to do during an asthma attack can help them feel more in control and encourage them to stay active.
• Avoid known trigger exposure, such as exercising in very cold and dry environments.

Exercise is essential for health and well-being, especially for kids with asthma. Not only does exercise help build strong muscles and bones, but it’s also proven to improve quality of life by reducing depression, combating stress, and promoting better sleep. Unfortunately, fears of an asthma attack can make certain activities seem scary for parents and caregivers. But with a few precautions and a defined treatment plan, your family can feel safe while enjoying an active lifestyle.

Exercise and Asthma Attacks

For some people with asthma, intense physical activity causes symptoms such as:

• Chest tightness
• Coughing
• Fatigue
• Shortness of breath
• Wheezing

Because of these symptoms, children with exercise-induced asthma may be reluctant to participate in physical activity. Their performance can also suffer, making it more difficult to keep up with their peers during exercise. If symptoms don’t improve, the child may have breathing difficulties and need emergency medical care.

Causes and Risk Factors

Doctors aren’t completely sure what causes exercise-induced asthma, but the weather and other environmental factors seem to play a role. Cold air is drier than warm air. Therefore, for some people, the dry air in cold weather may cause the air passages to dry out when breathing heavily during exercise, especially in cold-weather sports like ice-skating or ice hockey. For others, irritants like chlorine in pools, air pollution, allergens, and high pollen counts can trigger breathing difficulties. Endurance sports that require deep breathing for long periods of time, such as long-distance running, also raise the risk of exercise-induced asthma attacks.

Getting Diagnosed

Your child’s health care provider can perform a couple of tests to diagnose exercise-induced asthma. They’ll use a device called a spirometer to measure lung function. First, your child will inhale as deeply as possible while resting. Then, they’ll breathe hard and fast into the spirometer. They may repeat the test after using an inhaled bronchodilator asthma medicine (drugs that widen the airways) to see if there’s any improvement.

Your child’s provider may also suggest an exercise challenge test. During this test, your child will do supervised physical activity, like using a stationary bike or treadmill. They’ll use the spirometer before and after the challenge to see how exercise affects lung function.

Another test option is a methacholine breathing test. Methacholine is a substance that causes airway constriction. It is used in medical tests to see how easily the airways in the lungs can tighten, which helps diagnose conditions like asthma. Your child will inhale it at the doctor’s office to mimic an exercise-induced asthma attack, breathing into the spirometer before and after as part of the test.

Exercise-Induced Asthma Treatment

Children with exercise-induced asthma may need long-term control medication to keep asthma symptoms at bay. They’ll take this medication daily to help prevent asthma attacks and make breathing easier during exercise.

Examples of long-term asthma medications include:

• Combination inhalers — These are long-acting beta-agonists (LABAs) mixed with a corticosteroid (steroid) for short-term and long-term relief.
• Inhaled corticosteroids — This inhaled medicine reduces lung inflammation. It may take four weeks of treatment before the full benefits kick in.
• Leukotriene modifiers — These medications help control asthma and allergies by blocking or reducing the effects of inflammatory substances called leukotrienes in the body.

Children with infrequent symptom flares may also take short-acting medication, also known as rescue inhalers, before exercise to help prevent an asthma attack. Short-acting beta-agonists (SABAs) like albuterol and levalbuterol help open the airways. But you’re not supposed to use them daily. Another quick-acting inhaler is ipratropium, which relaxes and widens the airways to improve breathing.

Your child’s doctor can explain how far in advance to take medication before exercise. Keeping track of how much and how often your child uses these medications can help their doctor decide if they need better long-term control. Remember to ask about any potential side effects in advance so you know what to watch out for when your child starts a new medication.

Taking asthma medication is the No. 1 way to prevent an exercise-induced attack. In addition, warming up for 15 minutes before engaging in intense exercise and breathing in through the nose can help warm and humidify outside air before it reaches the lungs, reducing the risk of asthma symptoms.

Responding to an Asthma Attack

As soon as you feel your child is old enough, start teaching them what to do during an asthma attack. Although asthma attacks are very stressful, staying calm is crucial so you can respond effectively. Discussing the plan ahead of time can help. Your child’s doctor can help by providing an asthma action plan for school or sports. It’ll contain clear instructions for coaches, school nurses, and teachers about what to do if your child has an asthma attack.

Make sure your child has up-to-date medication, including clearly labeled rescue inhalers. In addition, the action plan should be on-site when your child participates in sports or other physical activities. Aside from instructions for responding to an attack, this document should have the phone number of the child’s doctor and the local emergency room. If the asthma attack gets resolved, it’s still a good idea to follow up with the pediatrician, allergist, or pulmonologist to report what happened and see if they recommend coming in for an office visit.

Sometimes, an asthma attack warrants a trip to the emergency room. If your child’s rescue inhaler isn’t providing quick relief, it’s time to seek further treatment. Signs that it’s time to go to the hospital include persistent shortness of breath, a lasting cough, and wheezing despite fast-acting treatment, “retracting” or visibly pulling in air by straining the neck and the ribs, and trouble speaking. In addition, color changes, including fingernails and lips that start turning gray or blue, can mean your child isn’t getting the oxygen their body needs.

Asthma attacks can be life-threatening, but they shouldn’t stop your child from being physically active. After all, many elite athletes, including those in the Olympics, have asthma. With the right prevention plan and a clear strategy for emergencies, your child can benefit from the many health benefits exercise has to offer. Talking to your child about overcoming challenges and taking control of their health is a lesson that they can use both on and off the sports field.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 10,000 members come together to ask questions, give advice, and share stories with others who understand life with asthma.

Have you had to manage the symptoms of exercise-induced asthma for yourself or your child? What type of asthma management plan has worked for your family? Share your experience in the comments below, or start a conversation by posting on your Activities page.