Exercise-induced bronchospasm in children and adolescents.

The early recognition and appropriate management of EIB can allow children and adolescents to participate fully in physical activities and sport. The diagnosis by history of chest congestion, coughing, and decreasing performance with exercise is helpful but is aided by a more systematic questionnaire that can detect otherwise "normal" people with EIB. The diagnosis is documented by performance of an exercise challenge test such as a treadmill or cycloergometer to verify bronchospasm induced by exercise. The management can be accomplished by nonpharmacologic means such as an early vigorous warm-up, the use of a mask for rebreathing warmed air, and participation in a physical training program to increase anaerobic fitness. Pharmacologic management includes the appropriate use of cromolyn sodium, beta-adrenergic agonists, theophylline, ipratromium bromide, and calcium channel blocking agents. In addition, the antihistamine, terfenadine, can be used to block EIB effectively. These pharmacologic agents can be utilized in both national and international competition when approved by the appropriate national governing body or the U.S. Olympic Committee and the International Olympic Committee.