Dyspnoea in the competitive paediatric athlete

Adolescent athletes are participating in sport in highly competitive environments. Dyspnoea associated with exercise is a common reason they are referred to paediatricians and respiratory specialists. The presentation with dyspnoea in adolescent athletes needs teasing out on history, examination and investigations from numerous conditions including exercise-induced bronchoconstriction, exercise-induced asthma (where exercise is a trigger for exacerbation of pre-existing asthma), vocal cord dysfunction, laryngeal dysfunction and physiological limitation to exercise.Exercise-induced bronchoconstriction is diagnosed by evaluating the magnitude of fall in FeV1 post exercise. This bronchoconstriction can be completely ameliorated by short acting beta agonists given prior to exertion. Their use is permitted by the WADA but there are concerns over tachyphylaxis with long-term use. Warm up before strenuous exercise can also help in limiting the degree of bronchoconstriction. Athletes with pre-existing atopic asthma benefit from inhaled corticosteroids and leukotriene receptor antagonists.Exercise associated upper airways obstruction maybe due to abnormal adduction of vocal cords or prolapse of the arytaenoid (subglottic) region. There may be psychological overlay. Diagnosis is by flexible nasoendoscopy and assessing the flow volume loops. Management is by reassurance and speech therapy.Exercise-induced hyperventilation and physiological limitations to exercise may also lead to perception of dyspnoea. Absence of cardiopulmonary abnormalities during exercise points towards these diagnosis.