Not all who wheeze have asthma

Abstract

Educational aimsExercise-induced asthma is frequently found among children, adolescents and young adults.The diagnosis of asthma should be documented by variable lung function, airway hyperresponsiveness and inflammation.Not all people who report exercise-induced respiratory symptoms have asthma.SummaryAsthma is characterised by respiratory symptoms such as shortness of breath and wheezing, and by exercise-induced symptoms. People with asthma frequently report symptoms during exercise; 90% of these people have exercise-induced asthma (EIA). Nevertheless, exercise-induced symptoms may mask other conditions or diseases, for instance poor physical fitness, exercise-induced laryngeal obstruction, hyperventilation and cardiomyopathy. Asthma symptoms should be documented and patients treated accordingly. With non-asthmatic exercise-induced symptoms, diseases in the laryngeal area are highly likely and patients should be examined while running. Although treatment options for laryngeal dysfunctions are limited, patients feel more in control when they know what is happening in their throat.

Safety, Efficacy, and Patient Acceptability of Montelukast in Exercise-Induced Asthma

“…9 It is important to be aware that exercise-induced symptoms could mask a variety of other diseases or conditions, such as poor physical fitness, vocal cord dysfunction (VCD), exercise-induced paradoxical arytenoid motion (EPAM), exercise-induced laryngomalacia (EIL), exercise -induced hyperventilation and hyper-trophic cardiomyopathy or arrhythmias with long Q-wave to T-wave interval QT. 10 The timing of the appearance of breathlessness in relation to exercise can provide some clue about an alternative diagnosis as the nadir of EIB happens 5 to 10 minutes after vigorous and sustained exercise, 11 as opposed to the shortness of breath experienced due to a lack of fitness or pre - existing airflow limitation where shortness of breath develops during exercise but improves afterwards.…”

Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction

“…However, no technique has shown good sensitivity and specificity33–35 and it is still difficult to diagnose EIVCD 36…”

Managing respiratory problems in athletes

“…An important differential or mimic of EIB is exercise-induced laryngeal obstruction (EILO), in which clinical features of dyspnoea and wheeze are generated from a transient obstruction of the upper airways during exercise (Table 3). 13 Bronchial provocation challenge is often necessary to establish definitive evidence of variable airflow obstruction (ie to demonstrate airway narrowing in response to a provocative substance, such as exercise). Specifically, an athlete performs serial spirometry tests before and following a challenge; typically looking for a 10% fall in forced expiratory volume (FEV 1 ) from baseline values.…”