Exercise-induced Respiratory Symptoms Research Articles

Prevalence and characterisation of exercise-induced laryngeal obstruction in patients with exercise-induced dyspnoea.

The prevalence of exercise-induced laryngeal obstruction is largely unknown. This study aimed to evaluate the prevalence of this condition in a selected study population of patients with exercise-induced dyspnoea. A retrospective analysis was conducted of demographic data, co-morbidities, medication, symptoms, performance level of sporting activities, continuous laryngoscopy exercise test results and subsequent treatment. Data from 184 patients were analysed. The overall prevalence of exercise-induced laryngeal obstruction in the study population was 40 per cent, and the highest prevalence was among females aged under 18 years (61 per cent). However, a high prevalence among males aged under 18 years (50 per cent) and among adults regardless of gender (34 per cent) was also found. The prevalence of exercise-induced laryngeal obstruction is clinically relevant regardless of age and gender. Clinicians are encouraged to consider exercise-induced laryngeal obstruction as a possible diagnosis in patients suffering from exercise-induced respiratory symptoms. No single characteristic that can distinguish exercise-induced laryngeal obstruction from other similar conditions was identified.

Differences in lung function, bronchial hyperresponsiveness and respiratory health between elite athletes competing in different sports

ABSTRACT The aim of this study was to examine lung function, bronchial hyperresponsiveness (BHR) and exercise-induced respiratory symptoms in elite athletes performing different sports. Norwegian national-team athletes (30 swimmers, 32 cross-country skiers, 16 speed-skaters, 11 rowers/paddlers, 17 handball players and 23 soccer players) completed a validated questionnaire, measured exhaled nitric oxide (FENO), spirometry, methacholine provocation (PD20met) and skin prick test. Three cut-off levels defined BHR; i.e. PD20met ≤2 µmol, ≤4 µmol and ≤8 µmol. Mean forced vital capacity (FVC) was highest in swimmers (Mean z-score[95%CI] = 1.16 [0.80, 1.51]), and close to or higher than reference values according to the Global Lung Initiative equation, across all sports. Mean forced expiratory volume in 1 s (FEV1) was higher than reference values in swimmers (0.48 [0.13, 0.84]), and ball game athletes (0.69 [0.41, 0.97]). Mean forced expiratory flow between 25 and 75% of FVC (FEF25-75), and/or FEV1/FVC were lower than reference values in all endurance groups. BHR defined by ≤2 and ≤8 µmol methacholine was observed in respectively 50%–87% of swimmers, 25%–47% of cross-country skiers, 20%–53% of speed-skaters, 18%–36% of rowers/paddlers, and 0%–17% of the ball game athletes. Exercise-induced symptoms were common in all groups, most frequent in cross-country skiers (88%), swimmers (83%) and speed-skaters (81%). Highlights Swimmers and ball game athletes had higher mean FVC and FEV1 when compared to the reference values predicted by the Global Lung Initiative (GLI) reference equation. Contrasting this, across all sports except ball game athletes, mean FEF25-75 and/or FEV1/FVC were lower than reference values. The prevalence of bronchial hyperresponsiveness (BHR) was high among elite athletes competing in swimming, cross-country skiing, speed skating and rowing/paddling, with swimmers being most affected. The majority of the elite athletes reported exercise-induced respiratory symptoms independent of lung function or BHR.

Bronchial asthma versus paroxysmal vocal-fold dysfunction in patients with exercise-induced respiratory symptoms

Background Most pulmonary physicians are treating patients with symptoms of wheezes as bronchial asthma. However, acute wheezing may occur owing to a distinct disease called vocal-fold dysfunction (VFD).Aim The aim was to differentiate bronchial asthma from VFD in patients experiencing exercise-induced respiratory symptoms.Patients and methods A total of 40 patients with exercise-induced respiratory symptoms who were admitted to Chest Diseases Department of Alexandria Main University Hospital and 20 healthy volunteers were recruited from March 2017 to October 2018 after obtaining informed consents from the participants and approval of the local ethical committee. All underwent full history taking, clinical examination, spirometry, auditory perceptual assessment, laryngovideostroboscopy, and acoustic analysis. Speech therapy was done for patients with VFD followed by spirometry after at least 6 months of treatment.Results VFD was higher in females, smokers, and patients with high BMI. Forced vital capacity (FVC), first second of forced vital capacity (FEV1), and FEV1/FVC showed statistically significant differences, to be lower in asthmatic patients. Forced expiratory flow at 50% of the vital capacity to forced inspiratory flow at 50% of the vital capacity (FEF50/FIF50) showed statistically significant difference, to be more than one in patients with VFD (P=0.001). Comparing patients with VFD before and after speech therapy showed no statistic differences regarding FVC, FEV1, and FEV1/FVC; however, strikingly there was a significant reduction in FEF50/FIF50 after speech therapy (P=0.001). Positive correlation was found between FEF50/FIF50 and BMI, Jitter%, and Shimmer dB.Conclusion Early recognition and precise identification of VFD can avoid inappropriate treatment. Spirometric evaluation is an available procedure that can be implemented for both identifying and monitoring of VFD. FEF50/FIF50 ratio more than one is suggestive of VFD. Speech therapy can be applied as a treatment of such condition.

Asthma and exercise-induced respiratory disorders in athletes. The position paper of the Polish Society of Allergology and Polish Society of Sports Medicine.

Exercise-induced respiratory symptoms describe acute airway narrowing that occurs as a result of exercise. It includes exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA) issues. To provide clinicians with practical guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB/EIA and to develop evidence-based guidelines for the diagnosis and treatment. Recommendations for the diagnosis and treatment of EIB were developed. High-intensity exercise in polluted environment (cold air, humidity, contamination, allergens) may increase the risk of EIB and asthma symptoms in athletes. Diagnostic procedures should include history taking, physical examination, atopy assessment and functional tests of the respiratory system. A strong recommendation was made for regular use of inhaled glucocorticosteroids and avoidance of short-acting β2-agonists as the only treatment. The treatment of asthma in athletes should always take into account current anti-doping regulations. This position paper reflects the currently available evidence.

Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team.

A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players. Prospective cohort design. Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014. Eighty-five soccer players (mean age: 20 ± 4 years) participated. Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59). The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB. Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens. Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs. This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.

Asthma and exercise-induced respiratory symptoms in the athlete: new insights.

Asthma and exercise-induced bronchoconstriction (EIB) are common in the athlete and can interfere with sport performances. In this review, we report recent findings on the prevalence, diagnosis and evaluation of these conditions, in addition to specific issues regarding their treatment and antidoping regulations. Recent studies confirmed the high prevalence of exercise-induced respiratory symptoms, asthma and EIB, in athletes and showed that these conditions are still underdiagnosed and undertreated. Recent studies highlight the suboptimal use of asthma medication in asthmatic and allergic athletes. Regarding the diagnosis and treatment, questions about the role and criteria for positivity of eucapnic voluntary hyperpnea test were raised. It was confirmed that there is a subgroup of athletes with poor response to asthma medication. Finally, regarding antidoping regulations, new methods and changes in criteria for urinary bronchodilator thresholds were suggested. Recent publications confirm that exercise-induced respiratory symptoms, asthma and EIB are common in athletes but often unrecognized and not optimally or successfully treated. It was suggested that current criteria for diagnostic bronchoprovocation test responses could be reassessed, as well as antidoping criteria for β2-agonists urinary levels. There is a need for more research on prevention of airways dysfunction in athletes, identification of different asthma phenotypes and the benefits of standard asthma medication in this population.

Exercice-induced bronchoconstriction among athletes: Assessment of bronchial provocation tests

Diagnosis of exercise-induced bronchoconstriction (EIB) requires the use of bronchial provocation tests (BPTs). We assessed exercise-induced respiratory symptoms (EIRS), EIB and asthma in athletes and evaluated the validity of BPTs in the diagnosis of EIB. Rhinitis and atopy were also assessed.Athletes with (n=55) and without previous asthma diagnosis (n=145) were tested by skin prick tests, lung function and eNO measurements. EIRS were recorded and EIB was assessed by methacholine (Mch), eucapnic voluntary hyperpnoea (EVH), mannitol and exercise test.EIRS were highly reported and history of asthma was common among athletes. A high prevalence of atopy (48.7%) and allergic rhinitis (30.5%) was found. Athletes with asthma had a higher response rate to Mch and to EVH, as compared with athletes without a previous asthma diagnosis (P=0.012 and P=0.017 respectively). Report of EIRS, rhinitis and atopy were not associated with a positive BPT response.Screening athletes for EIB using BPTs is suggested, irrespective of reported EIRS or a previous asthma diagnosis.

Two distinct phenotypes of asthma in elite athletes identified by latent class analysis

Introduction: Clusters of asthma in athletes have been insufficiently studied. Therefore, the present study aimed to characterize asthma phenotypes in elite athletes using latent class analysis (LCA) and to evaluate its association with the type of sport practiced. Methods: In the present cross-sectional study, an analysis of athletes’ records was carried out in databases of the Portuguese National Anti-Doping Committee and the Norwegian School of Sport Sciences. Athletes with asthma, diagnosed according to criteria given by the International Olympic Committee, were included for LCA. Sports practiced were categorized into water, winter and other sports. Results: Of 324 files screened, 150 files belonged to asthmatic athletes (91 Portuguese; 59 Norwegian). LCA retrieved two clusters: “atopic asthma” defined by allergic sensitization, rhinitis and allergic co-morbidities and increased exhaled nitric oxide levels; and “sports asthma”, defined by exercise-induced respiratory symptoms and airway hyperesponsiveness without allergic features. The risk of developing the phenotype “sports asthma” was significantly increased in athletes practicing water (OR = 2.87; 95%CI [1.82–4.51]) and winter (OR = 8.65; 95%CI [2.67–28.03]) sports, when compared with other athletes. Conclusion: Two asthma phenotypes were identified in elite athletes: “atopic asthma” and “sports asthma”. The type of sport practiced was associated with different phenotypes: water and winter sport athletes had three- and ninefold increased risk of “sports asthma”. Recognizing different phenotypes is clinically relevant as it would lead to distinct targeted treatments.

Exercise-induced respiratory symptoms and allergy in elite athletes: Allergy and Asthma in Polish Olympic Athletes (A(2)POLO) project within GA(2)LEN initiative.

Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes. Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data. Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA(2) LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist. At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes. High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that - in diagnosis of EIA - lung function testing alone is not useful, whereas reversibility tests are of limited value.

PO-0132 Acid Reflux Into The Oesophagus And Exercise: A Prospective Study In Children

<h3>Background and aims</h3> It has been reported that gastro-oesophageal reflux (GOR) can be induced by exercise, as described in adult subjects; studies in children are lacking. We sought whether the presence of acid in the oesophagus may increase with exercise and its potential relationship with atopy and lung function in children. <h3>Methods</h3> We recruited 45 patients (M/F: 30/15) aged 11 ± 2.7 years with reported exercise-induced respiratory symptoms; subjects were asked for frequency of gastrointestinal symptoms. All patients did lung function before and after 24-h gastro-oesophageal (GO) pH monitoring; they also underwent exercise testing (treadmill) before removing GO catheter. GO-pH was also analysed for 6 min intervals before, during and after exercise. The gastro-oesophageal reflux disease (GORD) was defined as a 24-hour reflux index (IR) ≥ 4.5% and/ or symptom index ≥ 50%. Total serum IgE levels were also assessed. <h3>Results</h3> GORD was found in 11/45 (24.4%) of our patients; these children had also a higher IR score during exercise than patients without GORD (7.1 ± 18.5 vs 0.5 ± 2.3, p &lt; 0.05). A fall of GO-pH was recorded during exercise, greater in children with GORD as compared with those without (17.2 ± 42.2 vs 0.9 ± 6.4, p = 0.03). The exercise-induced fall in GO-pH was associated with frequent gastrointestinal symptoms and correlated with IgE levels and baseline FEV₁% (IgE: r = -0.37, FEV1%: r = -0.31, p &lt; 0.05 for both). <h3>Conclusions</h3> Our results suggest that oesophageal acidity increase with exercise, particularly in atopic children with frequent gastrointestinal symptoms and low baseline respiratory function.

Exercise-induced dyspnea is a problem among the general adolescent population

Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms.

Airway response to exercise measured by area under the expiratory flow–volume curve in children with asthma

BackgroundThe exercise challenge test is the gold standard for diagnosing exercise-induced bronchoconstriction; however, it produces negative results in many children with postexercise symptoms. ObjectiveTo assess the utility of the area under the expiratory flow–volume curve (Aex) to identify exercise-induced bronchoconstriction in children with asthma. MethodsData from the medical records of 221 children with asthma who underwent an exercise treadmill challenge (ETC) were analyzed. The relation between exercise-induced respiratory symptoms and results of the ETC were assessed, specifically, the maximal decrease in forced expiration in 1 second (FEV1) and the maximal decrease in the Aex. ResultsThe receiver operating characteristic curve showed that a decrease greater than 6% in the Aex was an optimal cutoff point to produce the fewest misclassified ETC results based on a greater than 10% decrease in FEV1. The results of multivariable logistic regression showed that a decrease greater than 6% in the Aex was comparable to a decrease greater than 10% in FEV1 during an ETC and was more closely related to the presence of exercise-induced respiratory symptoms. Measuring the Aex during a routine ETC allowed a confirmation of bronchoconstriction in an additional 49 children (44%) with asthma and exercise-induced respiratory symptoms. The Aex measurement increased the sensitivity and negative predictive value of ETC without a significant effect on ETC specificity. ConclusionMeasuring the Aex increases the sensitivity and negative predictive value of ETC without producing a significant change in ETC specificity. Applying a 6% decrease in the Aex as a cutoff point for a positive exercise challenge test result may prevent the underdiagnosis of exercise-induced bronchoconstriction in children with asthma and postexercise symptoms. Trial RegistrationThis study was registered at www.clinicaltrials.gov (NCT01798823).

Predictive Risk Factors for Airway Hyperresponsiveness in Children with Exercise-Induced Respiratory Symptoms

Predictive Risk Factors for Airway Hyperresponsiveness in Children with Exercise-Induced Respiratory Symptoms

Exhaled nitric oxide indicates poorly athlete's asthma

In athletes, exercise-induced respiratory symptoms are common and their assessment is time and resource consuming. The objective was to evaluate fractional concentration of exhaled nitric oxide (FENO) as a predictor of bronchial hyperresponsiveness (BHR) and of asthma. Eighty-seven elite athletes and a control group of 87 sedentary patients with symptoms suggesting asthma underwent measurements of FENO and of BHR by using methacholine provocation test (MCH) and eucapnic voluntary hyperpnoea (EVH) (athletes) or histamine provocation test (HIST) (controls). In athletes, elevated FENO (>30 ppb) was not associated with lung function-confirmed asthma or with MCH positivity, but receiver operating characteristics (ROC) analysis showed some predictive value for EVH positivity [Area Under Curve (AUC) 0.652, 95% confidence interval (CI): 0.53 to 0.78, P = 0.020]. However, the sensitivity (55%) and the specificity (71%) were poor. In sedentary patients, FENO was significantly associated with both confirmed asthma and HIST positivity, ROC analysis showing FENO to be significantly predictive for HIST positivity (AUC 0.83, 95% CI: 0.70 to 0.96, P = 0.001) and for asthma (AUC 0.74, 95% CI: 0.63 to 0.85, P < 0.001). The results suggest that in contrast to sedentary patients, FENO seems to be a poor predictor of BHR and of clinical asthma in elite athletes. We find it unlikely that FENO could be a useful screening tool in athletes with exercise-induced respiratory symptoms.

Exercise-induced hyperventilation: more common than appreciated

Exercise-induced respiratory symptoms, especially in adolescents, are common and are often not caused by asthma.1 Hyperventilation during exercise, breathing in excess of exercise metabolic requirements, is a cause of pseudoasthma,2 usually erroneously attributed to exercise-induced bronchoconstriction (EIB). We recently treated an adolescent with exercise-induced hyperventilation and identified 11 more individuals in 18 months with similar clinical features.

Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in nurses.

In order to assess prevalence and characteristics of exercise-induced respiratory symptoms (EIRSs) and exercise-induced bronchoconstriction (EIB) in health care workers, we performed a cross-sectional study including 48 female nurses from primary care settings and an equal number of female office workers studied as a control group. The evaluation of examined groups included completion of a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise and histamine challenge. We found a similar prevalence of EIRSs and EIB in both groups. EIB was closely related to asthma, atopy, family history of asthma, and positive histamine challenge in either group, while the association between EIB and daily smoking in nurses was of borderline statistical significance. Bronchial reaction to exercise was significantly higher in nurses than in controls with EIB. With the exception of exercise induced wheezing, EIRSs were weakly associated with EIB in both groups with a large proportion of false positive results.

Not all who wheeze have asthma

Educational aims 1. Exercise-induced asthma is frequently found among children, adolescents and young adults. 2. The diagnosis of asthma should be documented by variable lung function, airway hyperresponsiveness and inflammation. 3. Not all people who report exercise-induced respiratory symptoms have asthma. Summary Asthma is characterised by respiratory symptoms such as shortness of breath and wheezing, and by exercise-induced symptoms. People with asthma frequently report symptoms during exercise; 90% of these people have exercise-induced asthma (EIA). Nevertheless, exercise-induced symptoms may mask other conditions or diseases, for instance poor physical fitness, exercise-induced laryngeal obstruction, hyperventilation and cardiomyopathy. Asthma symptoms should be documented and patients treated accordingly. With non-asthmatic exercise-induced symptoms, diseases in the laryngeal area are highly likely and patients should be examined while running. Although treatment options for laryngeal dysfunctions are limited, patients feel more in control when they know what is happening in their throat.

Body mass index in Belgian schoolchildren and its relationship with sensitization and allergic symptoms

Results of studies of the influence of body mass index (BMI) on the allergic status are controversial. As a part of the Aalst Allergy Study, we assessed the prevalence of the different BMI categories (underweight, normal weight, overweight, and obesity) and a possible association between BMI and atopy in 1576 unselected Belgian schoolchildren, aged from 3.4 to 14.8 yr. BMI was used to determine weight status. Skin prick testing with the most common aeroallergens was performed. A parental questionnaire documented data on respiratory and allergic disorders, demographic characteristics and other potential risk factors for sensitization. Among the total children, 4.1% of the children were underweight, 14.5% were overweight, and 7.4% were obese. More girls than boys were overweight (p = 0.015). In the group of children older than 12 yr, we found more overweight (p = 0.03) and obese (p = 0.004) girls, and more obese boys (p = 0.004) than in the younger age groups. In contrast with reports in the literature, an increased prevalence of allergic sensitization in underweight girls only [adjusted odd ratio (OR(adj)) = 2.9, 95% confidence interval (CI): 1.3-6.4] was documented. A strong association between obesity and exercise-induced respiratory symptoms was found in both boys (OR(adj) = 14.5, 95% CI: 2.9-73.3) and girls (OR(adj) = 4.9, 95% CI: 1.3-17.4). No correlations with allergic respiratory symptoms, eczema, or rhinoconjunctivitis could be documented.

Gender differences in the prevalence of airway hyperresponsiveness and asthma in athletes

Although athletes have a high prevalence of airway hyperresponsiveness (AHR) and asthma, little is known about possible gender differences in regard to these features. We looked at the comparative prevalence of AHR, physician-diagnosed asthma and respiratory symptoms during exercise in female (F) and male (M) athletes. A retrospective analysis was done on 2 groups of athletes: Group 1 (n=100) taking part in a study on the prevalence of AHR to methacholine (PC(20)<16mg/ml) and Group 2 (n=698), taking part in a provincial survey on the prevalence of physician-diagnosed asthma. Subjects from both groups filled the same questionnaire on respiratory symptoms during exercise (breathlessness, wheezing and chest tightness). In Group 1, prevalence of AHR was significantly higher in female (60%) compared with male (21.5%, p<0.0001) athletes despite a similar prevalence of physician-diagnosed asthma (F: 17.1%, M: 15.4%, p>0.05). Respiratory symptoms during exercise were more frequently reported in females (37.1%, M: 16.9%, p=0.02); however, when corrected for the PC(20), this difference became non-significant. In Group 2, the prevalence of physician-diagnosed asthma was not different between genders (F: 12.5%, M: 14%, p>0.05) but respiratory symptoms during exercise were more often reported in female (19.4%) than in male (12.2%, p=0.01) athletes. This analysis shows a higher prevalence of AHR and exercise-induced respiratory symptoms in female compared to male athletes, but a similar prevalence of physician-diagnosed asthma. This suggested that the increase in respiratory symptoms in female athletes failed to translate into a higher prevalence of physician-diagnosed asthma.

Exercise‐induced respiratory symptoms are poor predictors of bronchoconstriction

Exercise-induced asthma (EIA) is a possible cause of poor physical performance in children. No data are available on the value of respiratory symptoms to discriminate children with bad physical fitness from children with EIA. We evaluated respiratory symptoms in school-age children during and after exercise in relation to EIA. The population of 149 primary schools (849 classes with 15,241 children) was enrolled in the study. EIB was assessed using the 6-min free-running-test (6MFRT) in 15,241 children. At the end or at premature arrest of the 6MFRT, signs reported by the children and clinical symptoms observed by supervising physicians were recorded. Peak flow measurements were obtained before and 5 and 10 min after the 6MFRT, a decrease of 15% or more being defined as significant. The 6MFRT was positive in 7.4% of primary schoolchildren. Girls were more likely to have a positive test than boys (8.5% vs. 6.4%, P < 0.001), and children living in urban areas more than those living in rural areas (8.9% vs. 7.0%, P < 0.01). Premature arrest was seen in 3.5% (i.e., n = 353) of the children. The main reasons for premature arrest were dyspnea and chest pain. Among them, only 21% had a positive 6MFRT, while 89% with a positive 6MFRT could terminate the test. Premature arrest, breathlessness, chest tightness, wheezing, and cough had a positive predictive value to detect a EIA of 21.9%, 20.8%, 36.4%, 41.2%, and 28.3%, respectively, and a sensitivity of 10.8%, 29.5%, 14.9%, 4.8%, and 13.0%, respectively. In conclusion, EIA was detected in 7.4% of schoolchildren. A slightly higher incidence was observed in girls and children from an urban area. Neither premature arrest nor clinical signs and symptoms were good predictors of EIA in primary schoolchildren.