A new study finds that obese kids with asthma may mistake being breathless for an asthma attack, which can lead to unnecessary use of asthma inhalers.

Researchers reviewed data on 58 children with asthma, half obese and half within normal weight range. The researchers assessed lung function, medication use, symptom patterns, doctor and ER visits, and quality of life. They found that the obese children often reported different symptoms than normal weight children did—shortness of breath rather than a cough. They were also three times more likely to use their asthma inhaler than the normal weight children.

“Obese children with asthma need to develop a greater understanding of the distinct feeling of breathlessness in order to avoid not just unnecessary medication use, but also the anxiety, reduced quality of life and health care utilization that come along with this misunderstood symptom,” said Jason Lang, a physician in the Division of Pulmonary Medicine at Nemours Children’s Hospital in Orlando, Fla and the lead researcher on the study.

The researchers say doctors treating obese children should consider weight loss management for their patients to help improve symptoms and reduce medication use.

The study was published online in the Journal of Allergy and Clinical Immunology.