Diagnosis in children with exercise-induced respiratory symptoms: a multi-centre study.

Pedersen, Eva SL; Ardura Garcia, Cristina; de Jong, Carmen CM; Jochmann, Anja; Moeller, Alexander; Mueller-Suter, Dominik; Regamey, Nicolas; Singer, Florian; Goutaki, Myrofora; Kuehni, Claudia E (2021). Diagnosis in children with exercise-induced respiratory symptoms: a multi-centre study. Pediatric pulmonology, 56(1), pp. 217-225. Wiley-Blackwell 10.1002/ppul.25126

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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

Observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC).

PATIENTS

We included children with EIS as 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 harmonised procedures for children seen for EIS. This article is protected by copyright. All rights reserved.

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