Unexplained limitation to exercise is a common clinical problem in children and adolescents.
Exercise-induced asthma (EIA) is the most common manifestation. Bronchodilators
and other medications have been used in prevention and treatment of EIA and should allow
the majority of patients with asthma to perform regular physical activity. Although
asthma is the most common cause, dyspnoea on exertion can be a result of other causes.
Restrictive thoracic cage abnormalities (scoliosis and pectus deformities) can produce
dyspnoea only on exertion. Vocal cord dysfunction syndrome or the less common
exercise-induced laryngomalacia and tracheobronchomalacia are often attributed to
asthma. Most common is dyspnoea associated with normal physiologic exercise limitation
but other causes can include exercise-induced hyperventilation, supraventricular tachycardia
and other cardiac abnormalities. Spirometry, and exercise testing with cardiopulmonary
monitoring, including gas exchange, provide useful data to sort out the various
causes and avoid inappropriate treatments.
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