Table 1.

Exercise-induced asthma: differential diagnosis [modified from Del Giacco et al. (1)].

Diagnosis	Patients	Symptoms	Test
Exercise-induced asthma	Children, asthmatic or not, during physical activities	Dyspnea, wheezing, cough, thoracic pain	Spirometry before and after exercise, refer to a sport medicine specialist
Exercise-induced vocal cord dysfunction	Asthmatic children and children active in sports	Symptoms occur during maximum effort. Symptoms disappear when exercise is stopped unless the patient continues to hyperventilate. The dyspnea is of inspiratory type. There are audible inspiratory sounds from the laryngeal area and no signs of bronchial obstruction No effect of pretreatment with inhaled bronchodilator	Exercise test with maximal exercise load, 6–8 min duration Direct laryngoscopy during exercise test
Exercise-induced hyperventilation	Children and adolescent active in sports, children in general	Hyperventilation with respiratory dyspnea and increased end-tidal CO2	Case history, observation during dyspnea
Exercise-induced anaphylaxis	Children and adolescent active in sports	Shortness of breath accompanied by pruritus, urticarial and low blood pressure	Allergy skin test, identify possible dietary triggers
Chronic lung diseases	Children affected by difficult to treat asthma, cystic fibrosis etc	Exercise limitation due to reduced lung function	Maximal exercise stress test with oxygen consumption, lung function test