Regular 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 shown to improve quality of life and mental health by reducing depression and anxiety, 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.

1. Recognize Signs of Exercise-Induced Asthma

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 decline, making it more difficult to keep up with their peers during exercise. If symptoms don’t improve, the child may have trouble breathing and need emergency medical care.

2. Understand the Causes and Risk Factors

Doctors aren’t completely sure what causes exercise-induced asthma, but weather and other environmental factors seem to play a role. Cold air is drier than warm air. 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 pool chlorine, air pollution, allergens, and high pollen counts can trigger breathing difficulties. Endurance sports that require lengthy periods of deep breathing, such as long-distance running, also raise the risk of exercise-induced asthma attacks.

3. Be Sure You Have an Accurate Diagnosis

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

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

4. Determine if Your Child Is Out of Shape or Has Exercise-Induced Asthma

A child who is just starting a new sport or isn’t used to exercise may be out of shape. If they engage in strenuous physical activity, they may easily get out of breath and have symptoms that can seem like asthma.

It’s important to know the difference between exercise-induced asthma and being out of shape. One key difference is that kids who are out of shape and winded from exercise usually recover much faster than a child who has exercise-induced asthma. If asthma symptoms persist or worsen with exercise — particularly in cold or dry environments — your child may be experiencing exercise-induced asthma and should be treated accordingly.

5. Know About the Forms of 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 — Long-acting beta-agonists mixed with a corticosteroid (steroid) for short-term and long-term relief
• Inhaled corticosteroids — Inhaled medicine that reduces lung inflammation but may take four weeks of treatment to fully kick in
• Leukotriene modifiers — Medicine that helps control asthma and allergies by blocking or reducing the effects of inflammatory substances called leukotrienes in the body

Children with infrequent symptom flare-ups may also take short-acting medication, also known as rescue inhalers, before exercise to help prevent an asthma attack. Short-acting beta-agonists like albuterol and levalbuterol help open the airways but shouldn’t be used 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 better long-term control is needed. Remember to ask about any potential side effects 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.

6. Approach Exercise Carefully

By taking some simple precautions, children with asthma can enjoy exercise and its benefits. Talk to your child’s doctor about activities that should be avoided, as well as how and when medicine should be taken before exercise or if symptoms begin during exercise.

Following these tips can help your child stay safe with exercise and reduce the risk of a potentially dangerous asthma attack:

• Do warmup exercises, such as walking or stretching, for 15 minutes before engaging in intense exercise.
• Breathe in through the nose to help warm and humidify outside air before it reaches the lungs.
• Wear a ski mask or scarf that covers the nose and mouth in cold conditions, or do indoor activities instead.
• Take short breaks and rest during exercise or sports activities.
• Slow down or stop if symptoms start, rather than push through the activity, which can worsen symptoms.
• If pollen or air pollution triggers asthma symptoms, avoid strenuous activity outside on days when air quality may be problematic.
• Cool down by walking or gently stretching after strenuous activity or exercise.

7. Teach Your Child How To Respond 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 to responding effectively. Discussing the plan ahead of time can help. Your child’s doctor can help by providing an asthma action plan with clear instructions for coaches, school nurses, and teachers about what to do if your child has an asthma attack at school or during sports.

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. This document should also include 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, 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.

8. Show Your Child Role Model Athletes With Asthma

Asthma attacks can be life-threatening, but — with caution and treatment — asthma needn’t stop your child from being physically active. After all, many elite athletes, including Olympic athletes, have asthma. With the right prevention plan and a clear strategy for emergencies, your child can reap 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 11,000 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.