{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:14:19Z","timestamp":1788542059362,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011576","name":"Inonu University","doi-asserted-by":"publisher","award":["The APC fee for the article was supported by the Inonu University Scientific Research Project under project number 5143."],"award-info":[{"award-number":["The APC fee for the article was supported by the Inonu University Scientific Research Project under project number 5143."]}],"id":[{"id":"10.13039\/501100011576","id-type":"DOI","asserted-by":"publisher"}]},{"award":["The APC fee for the article was supported by the Inonu University Scientific Research Project under project number 5143."],"award-info":[{"award-number":["The APC fee for the article was supported by the Inonu University Scientific Research Project under project number 5143."]}],"id":[{"id":"https:\/\/ror.org\/04asck240","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Exercise-induced bronchoconstriction (EIB) may persist despite apparently adequate asthma control and may remain unrecognized in children without prominent exercise-related symptoms. This study aimed to determine the prevalence of objectively confirmed EIB in children with controlled asthma who did not report prominent exercise-related respiratory symptoms and to identify factors associated with EIB. Methods: This cross-sectional study included 67 children with controlled asthma who underwent standardized exercise challenge testing with serial spirometry. Demographic, environmental, allergic, laboratory, aeroallergen sensitization, and baseline pulmonary function characteristics were evaluated. Children were classified as EIB-positive or EIB-negative according to their post-exercise FEV1 response. Factors associated with EIB were assessed using univariate analyses and multivariable logistic regression. Results: EIB was identified in 24 of 67 children (35.8%). Baseline pulmonary function was generally preserved and did not differ significantly between EIB-positive and EIB-negative children. A history of atopic eczema was more frequent in the EIB-positive group (37.5% vs. 14.0%; p = 0.035). Allergic rhinitis, food allergy, total IgE, eosinophil percentage, and aeroallergen sensitization were not significantly associated with EIB. In multivariable logistic regression, a history of atopic eczema remained associated with EIB (adjusted odds ratio, 3.95; 95% CI, 1.08\u201314.41; p = 0.038), although the wide confidence interval indicates substantial uncertainty in the effect estimate. Conclusions: EIB was objectively detected in more than one-third of children with controlled asthma without prominent exercise-related symptoms despite preserved baseline pulmonary function. A history of atopic eczema may help identify children with persistent susceptibility to exercise-induced airway narrowing who might otherwise remain unrecognized.<\/jats:p>","DOI":"10.3390\/children13091196","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:07:32Z","timestamp":1788538052000},"page":"1196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise-Induced Bronchoconstriction in Children with Controlled Asthma Without Prominent Exercise-Related Symptoms: Prevalence and Associated Factors"],"prefix":"10.3390","volume":"13","author":[{"given":"Ercan","family":"Y\u0131lmaz","sequence":"first","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-9397","authenticated-orcid":false,"given":"Nezihe","family":"Koker Ozer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdem","family":"Topal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0175-6650","authenticated-orcid":false,"given":"Recep","family":"G\u00fcnak\u0131n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1164\/rccm.201303-0437ST","article-title":"American Thoracic Society Subcommittee on Exercise-induced Bronchoconstriction. An official American Thoracic Society clinical practice guideline: Exercise-induced bronchoconstriction","volume":"187","author":"Parsons","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13052-024-01594-0","article-title":"Exercise-induced bronchoconstriction, allergy and sports in children","volume":"50","author":"Klain","year":"2024","journal-title":"Ital. J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/ppul.23951","article-title":"Global prevalence of exercise-induced bronchoconstriction in childhood: A meta-analysis","volume":"53","author":"Anzolin","year":"2018","journal-title":"Pediatr. Pulmonol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1002\/ppul.20506","article-title":"Eosinophils play a major role in the severity of exercise-induced bronchoconstriction in children with asthma","volume":"41","author":"Lee","year":"2006","journal-title":"Pediatr. Pulmonol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"275","DOI":"10.3109\/02770903.2011.555035","article-title":"Association of the asthma control questionnaire with exercise-induced bronchoconstriction","volume":"48","author":"Madhuban","year":"2011","journal-title":"J. Asthma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ppul.21542","article-title":"Evaluation of association between exercise-induced bronchoconstriction and childhood asthma control test questionnaire scores in children","volume":"47","author":"Chinellato","year":"2012","journal-title":"Pediatr. Pulmonol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/ppul.20556","article-title":"Value of surrogate tests to predict exercise-induced bronchoconstriction in atopic childhood asthma","volume":"42","author":"Lex","year":"2007","journal-title":"Pediatr. Pulmonol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Spergel, J.M. (2010). From atopic dermatitis to asthma: The atopic march. Ann. Allergy Asthma Immunol., 105.","DOI":"10.1016\/j.anai.2009.10.002"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4168\/aair.2011.3.2.67","article-title":"The atopic march: Progression from atopic dermatitis to allergic rhinitis and asthma","volume":"3","author":"Zheng","year":"2011","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_10","unstructured":"Global Initiative for Asthma (2026, August 09). Global Strategy for Asthma Management and Prevention, 2026 Update. Available online: https:\/\/ginasthma.org\/2026-gina-strategy-report\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4274\/jcrpe.2183","article-title":"Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children","volume":"7","author":"Neyzi","year":"2015","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tripodi, S., Barreto, M., Di Rienzo-Businco, A., Grossi, O., Sfika, I., Ragusa, G., Campisano, M., and Miceli-Sopo, S. (2016). Asthma Control Test and Bronchial Challenge with Exercise in Pediatric Asthma. Front Pediatr., 4.","DOI":"10.3389\/fped.2016.00016"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1900753","DOI":"10.1183\/13993003.00753-2019","article-title":"Technical standards for respiratory oscillometry","volume":"55","author":"King","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.jaci.2011.11.002","article-title":"Relating small airways to asthma control by using impulse oscillometry in children","volume":"129","author":"Shi","year":"2012","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/all.12268","article-title":"Atopic dermatitis and the atopic march revisited","volume":"69","author":"Dharmage","year":"2014","journal-title":"Allergy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000502958","article-title":"Atopic March: Collegium Internationale Allergologicum Update 2020","volume":"181","author":"Aw","year":"2020","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.alit.2018.04.013","article-title":"An independent relation of atopic dermatitis to exercise-induced wheezing in asthmatic children","volume":"68","author":"Honjo","year":"2019","journal-title":"Allergol. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1399-3038.2005.00327.x","article-title":"Exercise-induced bronchoconstriction in children with atopic eczema","volume":"16","author":"Caffarelli","year":"2005","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.niox.2012.05.002","article-title":"Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma","volume":"27","author":"Grzelewski","year":"2012","journal-title":"Nitric Oxide"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1196\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:28:00Z","timestamp":1788539280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["children13091196"],"URL":"https:\/\/doi.org\/10.3390\/children13091196","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}