Abstract
Exertional dyspnea is a common complaint in general pediatric practice. While a high proportion of the general pediatric population has asthma, other diagnoses, including exercise-induced laryngeal obstruction should be considered, especially when asthma therapy is not sufficient to control symptoms. This review describes some of the key clinical features of exercised-induced laryngeal obstruction as well as preferred diagnostic and therapeutic approaches. Importantly, current diagnostic technology has considerably improved in the last decade at specialty centers. At the same time, infrastructure for clinical trials is emerging and there is not strong evidence to support specific therapies at the current time.
Highlights
Exertional dyspnea is a common presenting complaint in a general pediatric population
Among primary respiratory conditions leading to exertional dyspnea in pediatric populations, asthma is thought to be the most common cause, affecting nearly 300 million people globally and 10% of pediatric populations [6, 7]
Exercise-induced laryngeal obstruction (EILO) is defined by the presence of laryngoscopically visible upper airway obstruction that occurs during exercise before self-resolving [8]
Summary
Exertional dyspnea is a common presenting complaint in a general pediatric population It is an important symptom regardless of cause because it may affect quality of life and willingness to exercise in an age characterized by concerns about decreased physical activity [1,2,3]. It may be a reflection of conditioning status or underlying pathology in a variety of organ systems [4]. EILO is defined by the presence of laryngoscopically visible upper airway obstruction that occurs during exercise before self-resolving [8] By definition, this same obstruction does not occur at rest. Obstruction at either the glottic or supraglottic level is sufficient to make a diagnosis, the precise degree of obstruction at either anatomic level which differentiates 1) normal upper airway function from 2) an observed abnormality lacking clinical significance from 3) a clinical problem has not been defined
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