Exertional Dyspnea; Just an Untrained Child? Two Case Reports Analyzing the Role of Lung Function Testing

Abstract

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 dyspnea are exercise-induced bronchoconstriction, inducible laryngeal obstruction, and being physically untrained. 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). 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. 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.