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Poor physical fitness or fitness that is not up to par with the activity at hand is something I see on a regular basis. A common complaint from parents is that their son or daughter begins running track at school and suddenly starts feeling shortness of breath and chest pain during practice. Sometimes children cough with exercise. Some will even get the sensation of wheezing or noisy breathing. These are all very common complaints in patients with asthma, so often the child will be prescribed an asthma inhaler; if this does not help, then inhaled steroids are prescribed. But sometimes, the symptoms persist.
Pediatric pulmonologists have extensive experience dealing with children’s sleep and asthmatic problems. During the initial consultation, I conduct a pulmonary function test. I perform a cardiopulmonary stress test with pulmonary function where the distinction can be made between poor physical fitness and exercise-induced asthma. Treatment for poor physical fitness is easy: Increase the child’s physical activity and endurance and remove the unnecessary medication. Further investigations can include exercise testing, overnight sleep studies, and/or allergy testing.
We’re better at diagnosis and management of childhood asthma than ever before. Doctors and parents, however, need to make sure that the diagnosis of asthma is correct. As one of my professors taught me: “All that wheezes is not always asthma. All that is asthma may not always wheeze.”
