Welcome to the training on Exercise-Induced Dyspnea provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and other interested health-care professionals to diagnose and treat exercise-induced dyspnea in the primary care setting and to make appropriate referrals to specialists and subspecialists when needed.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Differentiate exercise-induced bronchospasm and vocal cord dysfunction—two common conditions associated with dyspnea—from asthma.
- Specify findings of the medical history, physical exam, and spirometry that can indicate exercise-induced bronchospasm.
- Specify conditions that are associated with vocal cord dysfunction.
- Evaluate when to refer a patient with exercise-induced dyspnea to a specialist or subspecialist.
Note: In this module, the term "children" refers to children and adolescents through age 20.
Please note this module expires on 6/10/2022.
This module was released on 6/10/2019.
Continuing Medical Education
This activity has been planned and implemented with the accreditation requirements and policies of the Texas Medical Association (TMA) through the joint providership of the Texas Department of State Health Services Continuing Education Service and Texas Council of Community Centers. The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Social Work Education.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.00 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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- Abu-Hasan, M., Tannous, B., & Weinberger, M. (2005). Exercise-induced dyspnea in children and adolescents: If not asthma then what? Annals of Allergy, Asthma & Immunology, 94:366-371.
- Alius, M.G., Pané-Farré, C.A., Von Leupoldt, A., & Hamm, A.O. (2013). Induction of dyspnea evokes increased anxiety and maladaptive breathing in individuals with high anxiety sensitivity and suffocation fear. Psychophysiology, 50(5), 488-497.
- Allen, T. W. (2005). Sideline management of asthma. Current Sports Medicine Reports, 4:301-304. [Abstract].
- Allen, T. W. (2005). Return to Play Following Exercise-Induced Bronchoconstriction. Clinical Journal of Sports Medicine, 15(6):421-425. [Abstract].
- American Academy of Pediatrics. (n.d.). National Center for Medical Home Implementation.
- Bhatia, R. (2015). Focus on Subspecialities: Exercise-induced dyspnea can have many causes. American Academy of Pediatrics, AAP News.
- Bogaerts, K., Karolien, N., Van Diest, I., Devriese, S., De Peuter, S., & Van den Bergh, O. (2005). Accuracy of respiratory symptom perception in different affective contexts. Journal of Psychosomatic Research, 58(6), 537-543.
- Dantas, F. M. N. A., Correia, M. A. V., Silva, A. R., Peixoto, D. M., Sarinho, E. S. C., & Rizzo, J. A. (2014). Mothers impose physical activity restrictions on their asthmatic children and adolescents: an analytical cross-sectional study. Biomed Central Public Health, 14:287.
- Doshi, D. R. & Weinberger, M. M. (2006). Long-term outcome of vocal cord dysfunction. Annals of Allergy, Asthma, & Immunology: 96(6): 794-9.
- Del Giacco, S. R., Firinu, D., Bjermer, L., & Carlson, K. H. (2015). Exercise and asthma: an overview. European Clinical Respiratory Journal, 2:27984.
- Fitzgerald, D. A. (2017). The weighty issue of obesity in paediatric respiratory medicine. Paediatric Respiratory Review, 24(4), 4-7.
- Fretzayas, A., Moustaki, M., Loukou, I., & Douros, K. (2017). Differentiating vocal cord dysfunction from asthma. Journal of Asthma and Allergy, 10: 277-283.
- Hayen, A., Herigstad, M., & Pattinson, K .T. S. (2013). Understanding dyspnea as a complex individual experience. Maturitas, 76(1), 45-50.
- Herigstad, M., Hayen, A., Wiech, K., & Pattinson, K. T. S. (2011). Dyspnoea and the brain. Respiratory Medicine, 105(6), 809-817.
- Kaslovsky, R., & Sadof, M. (2014). Spirometry for the Primary Care Pediatrician. Pediatrics in Review, 35(II): 465-471.
- Lands, L. C. (2017). Dyspnea in Children: What is driving it and how to approach it. Paediatric Respiratory Reviews, 24, 29-31.
- Lang, J. E., Hossain, J., & Lima, J. J. (2015). Overweight children report qualitatively distinct asthma symptoms: Analysis of validated symptom measures. The Journal of Allergy and Clinical Immunology, 135(4), 886-893.
- Lee, S-Y; Kim H-B, & Hong, S-J. (2009). Exercise-induced Asthma in Children. Expert Review of Clinical Immunology, 5(2):193-207:
- National Asthma Education and Prevention Program. (2007). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
- Newsham, K. R., Klaben, B. K., Miller, V. J., & Saunders, J. E. (2002). Paradoxical vocal-cord dysfunction: Management in athletes. Journal of Athletic Training;37(3):325-328.
- Parsons, J. P., & Mastronarde, J. G. (2009). Exercise-induced asthma. Current Opinion in Pulmonary Medicine;15:25-28.
- Randolph, C. (2005). Making the diagnosis of asthma in the athlete. Clinical Reviews in Allergy and Immunology;29:113-122.
- Rietveld, S., & van Beest, I. (2007). Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception. Behaviour Research and Therapy, 45(5), 977-987. [Abstract].
- Røksund, O. D., Olin, J. T., & Halvorsen, T. (2018). Working Towards a Common Transatlantic Approach for Evaluation of Exercise-Induced Laryngeal Obstruction. Immunology and Allergy Clinics of North America, 38(2): 281-292.
- Rundell, K. W. & Slee, J. B. (2008). Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes. Journal of Allergy and Clinical Immunology;122:238-46.
- Seear, M., Wensley, D., & West, N. (2005). How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren? Archives of Disease in Childhood, 90:898–902.
- Shim, Y. M., Burnette, A., Lucas, S., Herring, R. C., Weltman, J., Patrie, J. T. … Platts-Mills, T. A. (2013). Physical Deconditioning as a Cause of Breathlessness among Obese Adolescents with a Diagnosis of Asthma. PLOS One, 8(4):e61022.
- St. Louis Children’s Hospital. (2019). Vocal Cord Dysfunction (VCD): What is Vocal Cord Dysfunction?
- Weiler, J. M., Bonini, S., Coifman, R., Craig, T., Delgado, L., Capão-Filipe, M., . . . Storms, W. (2007). American Academy of Allergy, Asthma and Immunology work group report: Exercise-induced asthma. Journal of Allergy and Clinical Immunology;119(6):1349-1358.
- Weinberger, M. & Abu-Hassan, M. (2009). Perceptions and pathophysiology of dyspnea and exercise intolerance. Pediatric Clinics of North America;56:33-48.
The medical definitions provided in this module were obtained or adapted from the American College of Allergy, Asthma & Immunology; the American Thoracic Society; the Free Medical Dictionary; the Mayo Clinic; Respiratory Physiology & Neurobiology, the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services; the U.S. National Library of Medicine, and WebMD.
- American Thoracic Society, Patient Information Series: Breathlessness fact sheet.
- Breathe Easy Play Hard Foundation, a national nonprofit that provides educational resources and guidance to young people with asthma, offers online resources for parents and children.
- Kids Health from Nemours, Exercise-Induced Asthma. In Spanish.
- PBS. Calming Breathing Exercise for Kids.
- Texas Health Steps. Website offers general information about Texas Health Steps, including how to find a doctor or dentist.
Identifying and Treating Children with Asthma
Equip Texas Health Steps providers and other health-care professionals to identify asthma, apply a stepwise treatment approach as part of managing asthma patients in a primary care setting and make appropriate referrals for specialty care.