Exercise Related Respiratory Problems in the Young-Is It Exercise-Induced Bronchoconstriction or Laryngeal Obstruction?

Maria Vollsæter,Astrid Sandnes,Robert Maat,Hege Clemm,Ola Drange Røksund,Trine Stensrud,Thomas Halvorsen

doi:10.3389/fped.2021.800073

Abstract

Complaints of breathlessness during heavy exercise is common in children and adolescents, and represent expressions of a subjective feeling that may be difficult to verify and to link with specific diagnoses through objective tests. Exercise-induced asthma and exercise-induced laryngeal obstruction are two common medical causes of breathing difficulities in children and adolescents that can be challenging to distinguish between, based only on the complaints presented by patients. However, by applying a systematic clinical approach that includes rational use of tests, both conditions can usually be diagnosed reliably. In this invited mini-review, we suggest an approach we find feasible in our everyday clinical work.

Highlights

Exercise related breathing complaints are common in children and adolescents, and a scenario all clinicians must be prepared to encounter
Normal physiological exercise limitations were demonstrated in 52%, exercise induced bronchoconstriction (EIB) in 8%, and symptoms of exercise induced laryngeal obstruction (EILO) in 9%
Other forms of strenuous activity can be applied to elicit the symptoms [70, 72], an appropriate heart rate should be achieved. This may be accompanied by spirometry, or by close observation of breathing patterns during and after exercise, in order to differentiate between the two conditions EIB and EILO (Figure 1)

Summary

INTRODUCTION

Exercise related breathing complaints are common in children and adolescents, and a scenario all clinicians must be prepared to encounter. Despite guidelines prescribing objective test methods [4], studies suggest that asthma and EIB are often diagnosed based on wheeze as presenting symptoms, which is a highly questionable strategy [3, 10,11,12] The purpose of this mini-review is to outline a practical diagnostic approach to children and adolescents presenting with exercise induced breathing complaints, focusing on separating EIB from EILO. Other forms of strenuous activity can be applied to elicit the symptoms [70, 72], an appropriate heart rate should be achieved This may be accompanied by spirometry, or by close observation of breathing patterns during and after exercise, in order to differentiate between the two conditions EIB and EILO (Figure 1). As for EILO, there are currently no appropriate alternatives to the CLE-test

A SYSTEMATIC DIAGNOSTIC APPROACH TO EXERCISE INDUCED BREATHING COMPLAINTS

Findings

CONCLUSION