My ex-husband insists that our 11 year-old has asthma because she feels winded while exercising. I feel that response to exertion is natural. We both want what is best for her. How do I know if she needs to be tested or this condition?
Feeling winded or short of breath can be normal or abnormal in an 11 year old girl during exercise. At the beginning of the season, if the child has not been involved with another sport, the child’s endurance may be down and the increased oxygen demand of the activity would make the child breath heavier and deeper, alleviating eventually this feeling of being short of breath. However, should the child’s activity be consistent with her previous activity, then the shortness of breath may be related to several issues with the two most common in the age group being asthma and vocal cord dysfunction.
Asthma is found in 23 million people with a quarter of them in children under 18 years old, according the the American Academy of Pediatrics. Eighty to ninety percent of these are classified as mild to moderate in severity. It is the result of three changes and reactions in the tubes of the lungs. In asthma, muscles encircling the tubes spasm, causing the tubes to be smaller. The lining of the tubes swell, again closing off the airways. Furthermore, typically there is increased mucous production from all of this irritation, thus clogging the tubes, resulting in difficulty drawing in air. The most common symptoms associated with asthma are shortness of breath, coughing with exercising as well as in the middle of the night. Classically this would occur between midnight and 4AM, but in reality anytime at night is concerning. Other symptoms may also include a tightness in the chest and coughing while in cold air, while drinking ice cold drinks or while laughing. Children regularly will limit their activity because of these feelings. Frequently these symptoms worsen during cold season as well as during the major allergy seasons. Children with allergies and/or eczema are at a somewhat higher risk for asthma since they share similar etiologies. Treatment involves identifying the triggers leading to the tightening of the airways and inhaled medications. Sometimes for severe cases oral medication, extra oxygen or other medications may be needed.
For Vocal Cord Dysfunction exercise induced coughing is the main feature. Generally there is no significant coughing during sleep, allergies (beyond the usual cough from post nasal drip) and no chest tightness. Frequently children will mention that they feel as if they cannot take a breath in and that when they do, it seems to “get stuck” in the neck. This is a result of irritation of the vocal cords due to breathing through an open mouth while running and not through the nose. The function of the nose is to filter out any particulates of dirt and humidify the air before it goes down into the lungs. If the air is dry or dirty, the vocal cords can tighten up somewhat while the child is running around resulting in the feelings listed above. This is most often seen in adolescents and rarely in children younger than 11 or 12 years old. Although not listed in the information available from the American Academy of Pediatrics, my experience has been that it is more often in girls than boys. Treatment consists of training by a speech therapist who helps the child learn how to breath while running thus decreasing and hopefully eliminating the irritation causing the coughing.
If any of these symptoms are present, then the child should be evaluated in her own physician and then, if necessary, by either a pediatric allergist or pulmonologist, In this way, the proper diagnosis can be made.
Good luck,
DRTOM
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