An 11-year-old girl develops cough, chest tightness, and audible wheeze only during hockey practice, beginning about 10 minutes into play. Examination and spirometry between episodes are entirely normal. She plays four times a week. What is the most appropriate management?

• A Inhaled salbutamol 10 to 15 minutes before each session ✓
• B Inhaled budesonide twice daily throughout the year
• C Daily oral prednisolone during the sports season
• D Regular oral theophylline at night

Explanation

Exercise-induced bronchoconstriction occurring without baseline airway hyperresponsiveness is managed with two puffs of an inhaled short-acting beta-agonist taken shortly before exercise. Daily inhaled corticosteroids are reserved for frequent symptoms or coexistent persistent asthma, and regular systemic steroids are inappropriate. If pre-exercise salbutamol fails, a daily leukotriene receptor antagonist is the usual next step, not chronic oral therapy.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.