Why Does My Child Have Difficulty Breathing During Exercise?

Asthma isn’t the only reason your child may be struggling to breathe during sports. Here’s what parents should know about exercise-induced laryngeal obstruction and breathing pattern disorder.

Your child starts running, swimming, or playing a sport. Suddenly, they can’t seem to catch their breath. Maybe they experience a cough. Maybe they wheeze. Perhaps they mention that their throat or chest feels tight.

One of the first questions that parents often ask is, “Is this asthma?”

Sometimes the answer is yes. However, asthma isn’t the only cause of difficulty breathing during exercise.

One condition that may need to be considered is exercise-induced laryngeal obstruction (EILO).

What is EILO?

EILO, also referred to as paradoxical vocal fold motion (PVFM) or vocal cord dysfunction (VCD), is a condition in which the structures of the upper airway (the larynx, also known as your voice box) inappropriately narrow or close in response to high-intensity exercise.

With EILO, a child may experience:

• Sudden onset of shortness of breath
• Difficulty getting air in
• Throat or chest tightness
• High-pitched sounds when breathing (stridor)
• Cough
• The need to discontinue the activity to resolve their breathing problem
• Symptoms that resolve quickly after stopping exercise

How is EILO different than asthma?

Asthma, or exercise-induced bronchoconstriction (EIB), occurs when the lower airways narrow during or after exercise. Symptoms can include shortness of breath, coughing, wheezing, chest tightness, and difficulty breathing out.

In EILO, structures in and around the larynx narrow, making it difficult to get air through the upper airway.

EILO can often look similar to asthma. Many children are initially diagnosed with asthma because their symptoms occur during exercise. Some children may be prescribed an inhaler. When they experience little to no relief with an inhaler, other conditions, such as EILO, may need to be explored further.

It is important to know that EILO and asthma can and often co-exist.

One differentiator is the timing of symptoms.

In EILO, children often experience symptoms during high-intensity exercise, often at peak effort. Their breathing may suddenly become difficult and may be more noticeable when breathing in.

In asthma or EIB, symptoms may be more noticeable after exercise, and often involve wheezing, coughing, or difficulty breathing out.

These symptoms can be different for everyone, which is why proper evaluation matters.

We can’t forget breathing pattern disorder.

We also need to consider how your child is breathing.

Some athletes develop inefficient or poorly coordinated breathing patterns during exercise. They may breathe rapidly, take very large breaths, use excessive upper chest movement, or experience panic when their breathing becomes more difficult.

This can create a repetitive and negative cycle. And it doesn’t mean their breathing difficulty is “all in their head.” The difficulty they are experiencing is real.

Our breathing mechanics, airway function, exercise intensity, and our response to breathlessness all can influence one another.

What should parents do?

If you suspect any of these conditions, it is important to talk with your child’s medical provider.

Depending on the symptoms, proper evaluation and treatment may involve multiple specialists, including a pediatrician, pulmonologist, allergist, cardiologist, ENT, sports medicine physician, and speech-language pathologist.

Your child isn’t the only one.

Breathing problems during exercise can be extremely frustrating, especially for young athletes.

They may worry about what their peers or coaches think. They may avoid activities that they typically enjoy. They may become worried that their breathing could fail them during a practice or competition.

And parents can struggle to watch this happen.

These conditions are not simply something our young athletes can “push through.” There are different reasons a child may struggle to breathe during exercise, and getting the right diagnosis is an important first step toward finding the proper treatment.