The report by Seear et al found that most children referred to their clinic with a history of exercise induced asthma (EIA) did not have asthma.¹ These investigators conclude that the majority of exercise associated respiratory complaints can be diagnosed and managed without the need for exercise testing. The accompanying editorial concurs with that view.² Our own study, recently published, is supportive of the overdiagnosis of asthma as a cause of exercise induced dyspnoea (EID).³ However, I would argue against the conclusion that formal exercise testing is not indicated. In fact, our experience showed the value of full cardiopulmonary evaluation with breath-by-breath analysis of oxygen consumption and carbon dioxide production for such children during exercise sufficient to reproduce their symptoms.

By reproducing EID in 117 patients, most of whom had been previously …