Diagnosis in children with exercise‐induced respiratory symptoms: A multi‐center study

Abstract

Objective Exercise‐induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. Design An observational study of respiratory outpatients aged 0–16 years nested in the Swiss Paediatric Airway Cohort (SPAC). Patients We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2–17, 54% males) referred for EIS. Results The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%‐CI 46%–60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise‐challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. Conclusions Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow‐up differed between clinics and diagnostic groups highlighting the need for evidence‐based diagnostic guidelines and harmonized procedures for children seen for EIS.

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

“…Die Symptome erschwerte Atmung oder Atemnot (bei Sport oder Aktivität) könnten z. B. auch zu einem dysfunktionellen Atemmuster (wie "Induced Laryngeal Obstruction", ILO, oder "Vocal Cord Dysfunction", VCD), überwiegend thorakalem Atemmuster oder Hyperventilation passen, oder auf eine restriktive Lungenerkrankung hinweisen [144] (differenzialdiagnostisch muss eine kardiale Genese auch bei Kindern und Jugendlichen in Betracht gezogen werden). Je jünger die Kinder, desto schwieriger ist es, die Diagnose Asthma zu stellen.…”

Dysfunctional Breathing in Children: A Literature Review

“…An observational study involving respiratory outpatients aged 0-16 years reported the following findings: 16% of patients exhibited extrathoracic DB (ILO), 10% had thoracic DB (7% BPD, 1% hyperventilation, and 2% sighing tics), and 11% had asthma along with DB [10]. In a cross-sectional study in children with asthma, 5-18-year-olds had a 5.3% prevalence of DB, with a high prevalence among females (p < 0.002).…”

“…In adults, DB impacts 24-29% of individuals with asthma and 30-64% of those dealing with difficult asthma, while there is frequent relationship with ILO/VCD [20,21]. The prevalence of asthma with DB in pediatric population ranges from 5% to 18% [10][11][12], while DB has been associated with poorer asthma control and an increased utilization of beta2 agonists, and DB may potentially constitute a contributing factor in difficult-to-treat asthma [12].…”

Long term respiratory morbidity in patients with vascular rings: a review

“…Because spirometry provides a static measure of lung function, it doesn't evaluate the respiratory abilities to perform exercise, which is considered very important in the psychological and physical development of children and adolescents. Therefore, the exercise challenge test is helpful to reproduce exercise induced symptoms reported by patient [32], giving a complete idea of the clinical situation. The test should be obviously suitable for the patient's age (step test, six-minutes walking test, exercise test on treadmill or cycle ergometer).…”