Title:Exertional Dyspnea; Just an Untrained Child? Two Case Reports
Analyzing the Role of Lung Function Testing
Volume: 19
Issue: 4
Author(s): Domenico Paolo La Regina, Enrica Mancino, Elio Iovine, Mattia Spatuzzo, Fabrizio Virgili, Luigi Matera, Raffaella Nenna and Fabio Midulla*
Affiliation:
- Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
Keywords:
Exertional dyspnea, exercise-induced dyspnea, exercise-induced bronchoconstriction, exercise-induced laryngeal obstruction, lung function testing (LFT), pulmonary disease.
Abstract:
Background: Dyspnea is a common symptom that afflicts many patients with pulmonary
disease and may be the primary manifestation of not only lung disease but also myocardial
dysfunction, anemia, neuromuscular disorders, obesity, etc. Dyspnea can be induced by physical activity,
which is referred to as exercise-induced dyspnea (EID). It can be caused by various etiologies,
sometimes concomitant. In pediatrics, the three most common causes of exertional dyspnea
are exercise-induced bronchoconstriction, inducible laryngeal obstruction, and being physically untrained.
Case Presentation: We report two cases of adolescents who developed EID and their management
approach. The first patient had an inducible laryngeal obstruction (EILO), while the second had an
exercise-induced bronchoconstriction (EIB).
Discussion: The diagnosis of EIB is based on clinical symptoms (e.g., exercise-related symptoms
of dyspnea, cough, or wheezing) and lung function testing (LFT). This test shows a reversible airflow
limitation in response to exercise. A decrease in FEV1 ≥ 10% is considered positive. A major
goal is to ensure that patients with EIB continue physical activity. Therapy is based on non-pharmacologic
and pharmacologic measures.
Conclusion: Our aim is to add our experience to the available knowledge on the diagnosis of EID.
In conclusion, when faced with a child with exertional dyspnea, before declaring that he is not
trained, it is always necessary to collect an accurate medical history, examination and carry out
LFT, excluding pathologies of the upper and lower respiratory tract, such as EILO and EIB.
