Monday, September 1, 2014
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Cold-weather and exercise: A double whammy for some kids

Does your child get tired easily during or after exercise, or coughs after coming inside from being active outdoors? It could be exercise-induced asthma.

Cold-weather and exercise: A double whammy for some kids

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Does your child get tired easily during or after exercise, or coughs after coming inside from being active outdoors? It could be exercise-induced bronchospasm (EIB) or exercise-induced asthma, a condition in which people experience constriction of the airway when they exercise, producing symptoms such as wheezing or coughing.

For some, it can lead to shortness of breath and an inability to continue the exercise. EIB is common in asthmatics, but may also occur in those who do not have asthma. For children with EIB, winter weather poses special concerns. The cold, dry air combined with rapid breathing during exercise are a combination that can trigger attacks of EIB.

The upper airways – the nose and mouth – act as an air conditioner, moisturizing and warming the air as it goes down into the lungs. When you are breathing rapidly, the dry, cold air doesn’t have a chance to warm up. Cold air is, to begin with, drier than warm air, because air at lower temperature has a lesser capacity to hold water. That is why even stepping out into the cold sometimes “takes your breath away.” The effects of cold and exercise are most pronounced with high ventilation sports, such as soccer, running, hockey and skiing.

If your child wheezes during activity in cold weather, see your allergist or pulmonary (lung) specialist. Both of these specialties treat asthma and related airway disorders, and they have the means to diagnose EIB by performing clinical tests that mimic the effects of EIB. Once the diagnosis is made, a treatment and management plan can be developed with the goal of allowing the patient to participate normally in the sports that they enjoy. Often a medication such as albuterol, inhaled using a spacer, is effective in relieving symptoms. It may be used proactively before activity and also as symptoms arise.

EIB is particularly common in kids who participate at high levels in their sport because they tend to push themselves harder than recreational athletes do.  Studies have shown that up to 70 percent of Olympic athletes demonstrate symptoms of EIB.

EIB should not prevent kids from playing sports or being active. In fact, children nowadays don’t get nearly enough exercise to begin with. In many cases, EIB helps us diagnose underlying asthma because the patient will be more likely to seek attention if they are not able to participate in sports.   

In those patients with underlying asthma, first and foremost, their asthma should be kept under control. The key to successful management is to develop a plan to prevent episodes from happening during exercise. Such a plan involves integrated management that includes the patient, their parent(s), coaches, administrators, teammates and others, so that everyone recognizes those players who are affected by exercise. We know this can be successful because of the large number of world class athletes with asthma or EIB, who, with optimal management of their condition, are able to compete at the highest level of their sport.


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Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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