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Dyspnea during exercise in adolescents requires careful history to attempt to narrow down the diagnosis. Deconditioning is the most common cause of dyspnea in adolescents who exercise. Asthma is the most common underlying pathologic cause of difficulty breathing during exercise in adolescence. Differential diagnoses should be considered when asthma therapy (i.e. short-acting beta-agonist or inhaled corticosteroids) is ineffective for symptoms. Don’t miss serious cardiac pathology- ask about fam hx, chest pain, syncope. Consider the use of CPET testing if there is diagnostic uncertainty.