Exercise-induced Bronchospasm In Children

What is exercise-induced bronchospasm?

Exercise induced bronchospasm, or EIB, is a condition where your child's airway swells and becomes narrow. The airway is made up of many tubes that carry air in and out of the lungs. With EIB, your child's airway tightens and swells after he exercises too hard, especially in cold weather. Exercise includes sports or other physical activities. Having your child's EIB treated will relieve his symptoms and let him lead an active life.

What causes exercise-induced bronchospasm?

The exact cause of EIB in children is not known. It is believed to occur when your child breathes air hard and fast while exercising. Breathing fast can cause your child's airway to lose water quickly, making it dry and cool. When this happens, your child's lungs will release certain chemicals that may tighten his airway. His body will try to re-warm his airway by increasing the amount of blood flow to it. This increase in blood flow may also cause your child's airway to swell. Your child's risk of having EIB increases if another family member has asthma.

What may trigger exercise-induced bronchospasm?

Things that may cause your child to have an EIB attack may be different for other children. An EIB attack is an episode of EIB. Doing too much exercise too fast may make your child have an EIB attack. Any of the following may trigger an EIB attack in your child:

• Aerobic exercises: Aerobic exercises may make your child breathe hard for long periods. These include basketball, ice hockey, long-distance running, and soccer.
  
  
• Exercising in cold and dry air: Your child's risk of EIB is increased when doing winter sports or activities. These include cross-country skiing, ice skating, swimming, and long-distance running.
  
  
• Exercising in dirty air: Your child may have EIB when he breathes in air that has allergens or irritants while exercising. Allergens (things that can cause an allergic reaction) and irritants can hurt your child's airway and lungs. Allergens include pollen, mold, and dander from animals and pets, such as cats and dogs. Irritants include dust, engine smoke, tobacco smoke, and other chemicals.
  
  
• Exercising while sick: This may be an infection in your child's nose, throat, sinuses, airway, and lungs. Your child may be more likely to have EIB if he exercises while he is sick.

What are the signs and symptoms of exercise-induced bronchospasm?

Signs and symptoms of EIB can appear while your child is exercising, or shortly after he is done. Symptoms usually last for 30 to 60 minutes, but can also last for days. Your child's symptoms may go away completely, and then return 12 to 16 hours after exercise. Your child may have one or more of the following:

• Physical signs and symptoms:
  
  
  • Abdominal (belly) pain.
    
    
  • Cough that is dry, or that may bring up mucus from his lungs.
    
    
  • Headache.
    
    
  • Muscle cramps.
    
    
  • Pain or tight feeling in his chest.
    
    
  • Sore throat.
    
    
  • Trouble breathing, such as being short of breath or wheezing (high-pitched sound when breathing).
  
  
• Performance problems:
  
  
  • Avoiding certain activities or decreased interest in doing physical activities.
    
    
  • Feeling out of shape.
    
    
  • Getting tired easily.
    
    
  • Trouble doing activities during certain seasons.
    
    
  • Trouble keeping up with friends or peers during exercise.

How is exercise-induced bronchospasm diagnosed?

Your child's caregiver will ask about your child's health and any medical problems he may have. This includes asthma, allergies, or lung infections. He may also ask if a family member has any medical conditions such as asthma or allergies. Tell your child's caregiver what his symptoms are, which activities cause them, and how often they occur. Tell your child's caregiver what medicine or other treatments have been used for your child's symptoms. Your child's caregiver will do a physical exam to check for conditions that may be causing his symptoms. Your child may need one or more of the following tests:

• Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from an artery usually in your child's wrist. ABGs may be done if your child has trouble breathing or other problems caused by his illness.
  
  
• Challenge tests: These include tests that will make your child breathe faster than he normally does. Your child will be asked to blow hard into a spirometer before and after the test. A spirometer is a device used to measure how much air your child breathes in and out. Your child may have EIB if the amount of air he breathes out has decreased after the test.
  
  
  • Bronchoprovocation test: This test uses certain medicines that cause narrowing of the airway. Your child may be asked to breathe in this medicine. After 10 minutes, your child's caregiver will measure how much air he breathes out. If the amount of air he breathes out decreases, your child has an increased risk of having EIB.
    
    
  • Eucapnic voluntary hyperventilation challenge: This test is also called EVHC. Your child will be asked to breathe in dry air quickly and deeply. This test is usually done for six minutes. Your child will then be asked to breathe into a spirometer. This test helps your child's caregiver check how much air your child can breathe in and out.
    
    
  • Exercise testing: Your child will be asked to exercise for a few minutes. He may be asked to walk or run on a treadmill, or pedal an exercise bike. This test is usually done inside a room where the air temperature is controlled. It may also be done where your child plays his sport. Your child will be asked to blow through the spirometer before and after his exercise. This test compares the spirometer readings and measures how much air your child can breathe.
  
  
• Peak flow test: This test measures your child's peak expiratory flow (PEF) using a peak flow meter (small tube-shaped device). PEF is the air your child blows out of his mouth. It shows how fast air moves out of his lungs which is usually decreased during an EIB attack. Your child's PEF can help show when your child needs to take medicines and when to stop exercising. It can also tell his caregiver if he needs to change your child's medicines. It is important that your child uses his peak flow meter correctly. Ask your child's caregiver how to correctly use a peak flow meter, and read PEF results.
  
  
• Pulmonary function tests: These tests, also known as PFTs, help your child's caregiver learn how well your child's lungs work. PFTs may also help your child's caregivers choose the best treatment for him. During the test, your child will breathe into a mouthpiece connected to a spirometer. This may help caregivers see how well your child's lungs are moving and working.

How is exercise-induced bronchospasm in children treated?

Your child may need to stay away from things or activities that trigger his EIB. He may be given medicines for his EIB that are taken by mouth (swallowed) or inhaled (breathed in). These medicines may be pretreatment (preventive), rescue (quick-relief), or controller medicines. Sometimes, your child may need to rest for a certain period of time before exercising. If your child is an athlete, ask his caregiver for written certificates for his medicines. These will be needed to make sure your child follows the rules about taking medicines while competing. Your child may have any of the following medicines:

• Allergy medicines: These medicines, also called anti-histamines, can treat allergies which may be causing your child's breathing problems. Taking these medicines can decrease your child's risk of having EIB.
  
  
• Bronchodilators: Bronchodilators may be given to help open the air passages in your child's lungs to help him breathe easier.
  
  
• Leukotriene inhibitors: These medicines can decrease the swelling in your child's lungs. They may stop your child from having more wheezing or shortness of breath. They may also prevent your child's attacks from lasting for long periods.
  
  
• Mast cell stabilizers: Mast cells are found in the smaller tubes in your child's lungs. They are in charge of releasing some chemicals that can cause your child's airway to narrow. This kind of medicine may help prevent your child's lungs from swelling.
  
  
• Steroids: Steroid medicine may help open your child's air passages so he can breathe easier. Give this medicine as ordered by your child's caregiver. Stopping this medicine without the caregiver's OK may cause a bad response.

What is an inhaler?

Your child's medicines may come inside small devices called inhalers. An inhaler gives your child's medicine in mist form which he can breathe into his lungs. A metered dose inhaler (MDI) is one type of inhaler. This is a small tube shaped device that holds the liquid asthma medicine inside. Your child may use a spacer with this inhaler. A spacer is a large tube which holds the mist inside it before your child breathes it in. This helps your child get the right amount of medicine. A MDI with spacer also decreases the risk of side effects, such as hoarseness, mouth yeast infection, and hacking cough. Ask your child's caregiver for information on how to use an inhaler correctly.

How can my child prevent exercise-induced bronchospasm?

Your child's caregiver will give you a written action plan. This plan contains your child's treatment instructions. It may also have information on how you can recognize symptoms of an EIB attack in your child. EIB may be prevented by any of the following:

• Breathing: Breathing through the nose, especially when exercising, may help prevent EIB. Nose breathing lets the outside air get warm before reaching your child's airway. Deep breathing will also help open your child's airway.
  
  
• Diet: Fish, or foods high in beta carotene and lycopene may help decrease your child's symptoms, or prevent EIB. A diet low in salt may also help. Supplements, such as vitamins C and E, and fish oils, may also help prevent EIB. Caffeine, found in coffee and other beverages, can help loosen your child's tight airway. Talk with your child's caregiver first before giving your child vitamins or supplements.
  
  
• Exercise area: EIB may be prevented by exercising indoors where the air can be controlled, and made warm and humid. Swimming pools, ice rinks, and other indoor arenas may have increased amounts of gases in the air. If chlorine or other gases trigger your child's EIB, an outdoor arena may need to be used. Outdoor physical activities should be avoided during the afternoon and evening when air pollution is highest.
  
  
• Medicine: Your child may take his medicines before doing exercise or physical activities to prevent EIB. If your child is given controller medicines, make sure he uses them as instructed by his caregiver. Your child should carry his inhaler with him at all times. He may also need vaccines to help protect his body from infection. Ask your child's caregiver if your child should get shots to help prevent the flu and pneumonia.
  
  
• Mouth and nose cover: Your child's mouth and nose should be covered when exercising outside. This helps warm the air he breathes in during cold weather. It may also help him from breathing in germ causing infections, allergens, and irritants. Your child may wear a scarf or mask, or use breathing masks or filters.
  
  
• Smoking: Do not smoke around your child or let your child smoke. Smoking can harm your child's heart, lungs and blood. It also increases his risk of certain types of infections. He is also more likely to get lung disease and cancer later in his life. If you or your child smoke, quit. If you are having trouble quitting, talk to your caregiver.
  
  
• Warm up or cool down exercises and rest: Light exercises, such as walking or stretching, should be done before doing heavy exercise or physical activities. Cool down for at least 10 minutes after heavy exercise. If your child has just eaten, have him wait for two hours before exercising. If your child has a respiratory infection, he should not exercise. Your child may need to rest for 2 to 3 weeks after being sick. Take your child to see his caregiver before he starts exercising again.

What are the risks of having exercise-induced asthma?

Your child's EIB may get worse if left untreated. He may have trouble doing his usual activities. Your child may begin to have more EIB attacks which last longer. His airway may become very swollen and tight. If your child's airway becomes too tight, he may not get enough oxygen to his body. This may cause damage to his organs, such as the heart and brain, and may cause death.

When should I call my child's caregiver?

Call your child's caregiver if:

• Your child has problems that may be caused by his medicines. These include shakiness, trouble thinking clearly, pounding or fast heartbeat, or upset stomach.
  
  
• Your child has increased wheezing, coughing, or trouble breathing even after taking his medicines.
  
  
• Your child's medicines do not relieve his symptoms.
  
  
• You or your child has questions or concerns about his condition, medicines, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your child has very bad pain in his chest.
  
  
• Your child has trouble thinking or faints.
  
  
• Your child is so short of breath that he has trouble walking and talking.
  
  
• Your child's chest and neck are pulled or sucked in with each breath.

Where can I find support and more information?

Having EIB can be hard for your child and your family. Learning more about your child's condition can help control his EIB. You and your child may want to join a support group with other people who have asthma. Contact the following for more information:

• American Academy of Allergy, Asthma, and Immunology
  555 E. Wells St, Suite 1100
  Milwaukee , WI 53202-3823
  Phone: 1- 800 - 822-2762
  Web Address: http://www.aaaai.org
  

• Asthma and Allergy Foundation of America
  8201 Corporate Drive, Suite 1000
  Landover , MD 20785
  Phone: 1- 800 - 727-8462
  Web Address: http://aafa.org
  

• National Asthma Education and Prevention Program
  National Heart, Lung and Blood Institute
  National Asthma Education and Prevention Program
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/about/naepp/
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Exercise-induced Bronchospasm In Children