The Need for Testing-The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea.

Vera S Hengeveld,John D Brannan,Boony J Thio,Mattiènne R Van Der Kamp

doi:10.3389/fped.2021.773794

Abstract

Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.

Highlights

Exertional dyspnea is a common presenting symptom within the pediatric population; up to 14% of the adolescent population experience exercise-induced dyspnea yearly [1]
The diagnosis of exercise induced bronchoconstriction (EIB) should never be made based on symptoms and/or reaction on reliever medication alone, but should be accompanied by data on changes in lung function in response to exercise or a surrogate challenge [27, 31]
Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom

Summary

INTRODUCTION

Exertional dyspnea is a common presenting symptom within the pediatric population; up to 14% of the adolescent population experience exercise-induced dyspnea yearly [1]. Exertional dyspnea in children, especially when having a history of asthma, is often primarily assumed to be caused by exercise induced bronchoconstriction (EIB), as asthma is a common and known entity in childhood. But less known causes of exertional dyspnea are dysfunctional breathing, Exercise Induced Larygneal Obstruction (EILO) and dyspnea when reaching the physiological limit [13,14,15,16,17,18]. Running on a treadmill requires well-coordinated movements and is less suitable for younger children In this age group (3–6 years) a jumping castle can be used to induce a rapid increase in heart frequency that is sustained over an extended bout length [55]. The rapid recovery of EIB in children, especially in younger children, underlines the importance to start spirometry measurements shortly after exercise (preferably 1 min after termination of exercise), because otherwise bronchoconstriction can be missed!

CONCLUSION

Findings

DATA AVAILABILITY STATEMENT