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Importance of taking a medical history when diagnosing exercise-induced symptoms

Published online: September 19, 2020

Many children consult with respiratory problems occurring during exercise, such as cough, shortness of breath or wheezy breathing. Asthma is the most common disease causing exercise-induced respiratory symptoms, but dysfunctional vocal cords, dysfunctional breathing patterns, chronic cough, or a low fitness level can also result in such problems. The correct diagnosis is often not easy to identify. Textbooks suggest that certain symptoms are typical for some underlying disorders. For example, in a child with asthma, symptoms are more likely to begin during exercise or after stopping, while symptoms typically begin at the start of exercise in a child with dysfunctional vocal cords. However, this knowledge comes from textbooks, and few studies really tested it.

In a study published in The Journal of Allergy and Clinical Immunology: in Practice, Pedersen et al. investigated which symptoms reported by parents can help doctors to identify the correct underlying diagnosis in children with respiratory problems during exercise.

The authors used data from the Swiss Paediatric Airway Cohort (SPAC), a study of children referred to specialized respiratory clinics in Switzerland for various respiratory problems. This analysis included data from 732 children aged 6 to 17 years with exercise-related problems. Parents completed a detailed questionnaire on their child’s symptoms before the visit to the clinic. Data on the final diagnosis given by specialized physicians in the clinic was afterwards extracted from hospital records. Diagnoses were categorized as:  asthma; extrathoracic dysfunctional breathing including abnormal function of vocal cords or larynx; thoracic dysfunctional breathing including abnormal breathing patterns; asthma plus dysfunctional breathing, and other diagnoses such as chronic cough and low fitness level.

The symptoms that were most helpful to distinguish between underlying diseases in this study were cough, shortness of breath, and tingling feeling in fingertips or lips. Cough was reported by parents more often for children with asthma, while shortness of breath and tingling feeling in fingertips or lips were reported most often for children with thoracic dysfunctional breathing. Onset and duration of symptoms were also helpful for diagnosis. In children with extrathoracic dysfunctional breathing, symptoms most often started during exercise while symptoms started after ending exercise in children with asthma. Symptoms lasted longer in children with thoracic dysfunctional breathing than in children with other diagnoses. In summary, the study confirmed that specific symptoms can help to distinguish different diagnoses in children with exercise-induced respiratory problems. This highlights the importance for physicians to ask detailed questions about a child’s symptoms.

The Journal of Allergy and Clinical Immunology: in Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician

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