Exercise-Related Respiratory Pathologies

Regular physical activity is essential for children’s health, yet it may trigger respiratory symptoms that limit exercise tolerance, particularly in school-aged children and adolescents. The most prevalent disorders are exercise-induced bronchospasm (EIB) and exercise-induced laryngeal obstruction (EILO). EIB affects up to 20% of the general population and 90% of individuals with asthma, with higher prevalence in athletes and adolescents. It typically presents with dyspnea, cough, and chest tightness after exertion. Diagnosis relies on exercise challenge spirometry with demonstration of reversible airflow limitation, while management includes preventive strategies (warm-up, environmental control, asthma education) and pre-exercise short-acting β2-agonists, with stepwise escalation in refractory cases.

EILO, increasingly recognized in adolescents and young women, is characterized by inspiratory stridor during exertion, in contrast to EIB where symptoms peak after exercise. Continuous laryngoscopy during exercise is the diagnostic gold standard, enabling both localization of obstruction and therapeutic demonstration. Non-pharmacological interventions such as speech therapy, breathing control techniques, and psychological support are central to management, with pharmacological therapy, antireflux treatment, or surgery reserved for selected cases.

The protocol developed by the Respiratory Airways Group of the Spanish Association of Primary Care Pediatrics (AEPap) provides a structured diagnostic-therapeutic algorithm. This tool supports pediatricians in primary care to differentiate between EIB and EILO and to implement tailored interventions, thereby ensuring adequate symptom control and promoting continued engagement in physical activity.