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News
When a teen athlete says they can't breathe, don't just assume asthma — long COVID may be the real culprit. A pediatrician at the AAP 2026 National Conference urged clinicians to dig deeper into the physiology behind breathing complaints in young athletes with post-COVID symptoms. From dysautonomia to mast cell activation syndrome, the causes are far more varied than traditional respiratory diagnoses.
When a teenage athlete says "I can't breathe," the instinct might be to reach for an asthma diagnosis — but in the long COVID era, that reflex could lead clinicians astray. At the AAP 2026 National Conference, pediatrician Suzanne McNulty, MD, urged colleagues to treat breathing complaints in young athletes as a systemic puzzle, not just a pulmonary one. The goal, she emphasized, isn't just getting an athlete through a workout — it's understanding the underlying physiology well enough to support safe return to sport.
McNulty outlined a structured approach: start by ruling out red flags (fainting on exertion, chest pain, stridor), then launch a thorough workup including spirometry, iron studies, orthostatic testing, and cardiac evaluation. Crucially, normal spirometry doesn't close the case — a 2024 meta-analysis of 386 post-COVID children found breathing symptoms despite normal lung function tests. Clinicians should also probe the type of breathlessness, since "air hunger" points to different causes than "my throat feels blocked."
Key Takeaways:
Why it matters: As long COVID continues to affect young people, clinicians need a broader diagnostic lens. Missing systemic causes like dysautonomia or MCAS can delay recovery and sideline athletes unnecessarily.
