Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC)

Eva S L Pedersen; Carmen C M de Jong; Cristina Ardura-Garcia; Maria Christina Mallet; Juerg Barben; Carmen Casaulta; Karin Hoyler; Anja Jochmann; Alexander Moeller; Dominik Mueller-Suter; Nicolas Regamey; Florian Singer; Myrofora Goutaki; Claudia E Kuehni

doi:10.1016/j.jaip.2020.09.012

Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC)

J Allergy Clin Immunol Pract. 2021 Feb;9(2):881-889.e3. doi: 10.1016/j.jaip.2020.09.012. Epub 2020 Sep 19.

Affiliations

¹ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ Division of Paediatric Pulmonology, Children's Hospital St. Gallen, St. Gallen, Switzerland.
⁵ Division of Paediatric Pulmonology, Children's Hospital Chur, Chur, Switzerland.
⁶ Division of Paediatric Pulmonology, Private Paediatric Practice Horgen, Horgen, Switzerland.
⁷ Division of Paediatric Pulmonology, University Children's Hospital, University of Basel, Basel, Switzerland.
⁸ Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland.
⁹ Division of Paediatric Pulmonology, Kantonsspital Aarau, Aarau, Switzerland.
¹⁰ Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland.
¹¹ Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland; PedNet, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.
¹² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.
¹³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland. Electronic address: Claudia.kuehni@ispm.unibe.ch.

PMID: 32961313
DOI: 10.1016/j.jaip.2020.09.012

Abstract

Background: Exercise-induced breathing problems with similar clinical presentations can have different etiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult.

Objective: We studied which parent-reported, exercise-induced symptoms can help distinguish diagnoses in children seen in respiratory outpatient clinics.

Methods: This study was nested in the Swiss Paediatric Airway Cohort, an observational study of children aged 0 to 17 years referred to pediatric respiratory outpatient clinics in Switzerland. We studied children aged 6 to 17 years and compared information on exercise-induced symptoms from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyze whether parent-reported symptoms differed between diagnoses (asthma as base).

Results: Among 1109 children, exercise-induced symptoms were reported for 732 (66%) (mean age: 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnea best distinguished thoracic DB (relative risk ratio [RRR]: 5.4, 95% confidence interval [CI]: 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR: 2.4, 95% CI: 1.3-6.2) and asthma plus DB (RRR: 1.8, 95% CI: 0.9-3.4) from asthma only. Late onset of symptoms was less common for extrathoracic DB (RRR: 0.1, 95% CI: 0.03-0.5) and thoracic DB (RRR: 0.4, 95% CI: 0.1-1.2) compared with asthma. Localization of dyspnea (throat vs chest) differed between extrathoracic DB (RRR: 2.3, 95% CI: 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses.

Conclusion: Parent-reported symptoms help distinguish different diagnoses in children with exercise-induced symptoms. This highlights the importance of physicians obtaining detailed patient histories.

Keywords: Adolescents; Asthma; Childhood; Dysfunctional breathing; Exercise-induced; ILO.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Asthma* / diagnosis
Asthma* / epidemiology
Child
Child, Preschool
Cough / diagnosis
Dyspnea
Female
Humans
Infant
Infant, Newborn
Respiration Disorders*
Switzerland