Medical health experts have known for years that there is a link between childhood obesity and asthma, but have found it challenging to distinguish which condition comes first, and whether or not one may lead to the other.

In an article published in the journal Annals of Allergy, Asthma and Immunology, allergist Perdita Permaul, MD, suggests that it is more likely that obesity in childhood leads to asthma. However, the relationship between the two conditions is an extremely complex one.

“The relationship between obesity and asthma in adults, which shows that being overweight and obese can precede the onset of asthma, is supported by a number of studies. There isn’t as much evidence for children, but the progression from obesity to asthma, rather than the other way around, seems probable,” said Permaul in a statement.

Many times physicians don’t know if constricted airways characteristic in asthmatic patients cause children to not want to be active, and therefore end up gaining weight over time, or if being overweight caused the narrowing of the airways, inevitably causing asthma.

The majority of children with asthma also suffer from allergies. Any allergic reactions can symptoms of allergies, including wheezing, shortness of breath, coughing, all of which make physical activity much more difficult for the child.

Children with asthma should generally be able to remain physically active, as long as they follow the advice of their physicians. When asthma is properly controlled, kids should be able to exercise safely.