Exercise-Related Respiratory Disorders

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). Exercise-induced bronchospasm affects up to 20% of the general population and 90% of individuals with asthma, with a higher prevalence in athletes and adolescents. It typically presents with dyspnea, cough, and chest tightness after exertion. Its diagnosis relies on exercise challenge spirometry with demonstration of reversible airflow limitation, while its management includes preventive strategies (warm-up, environmental control, asthma education) and administration of pre-exercise short-acting β₂-agonists, with stepwise escalation in refractory cases.

Exercise-induced laryngeal obstruction, increasingly recognized in adolescents and young women, is characterized by inspiratory stridor during exertion, in contrast to EIB, in which symptoms peak after exercise. Continuous laryngoscopy during exercise is the gold standard for diagnosis, as it allows both localization of the obstruction and therapeutic intervention. Non-pharmacological interventions such as speech therapy, breathing control techniques, and psychological support are central to management, with pharmacotherapy, anti-reflux 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 primary care pediatricians in differentiating between EIB and EILO and implementing tailored interventions to ensure adequate symptom control and promote continued engagement in physical activity.