青少年功能性呼吸障碍和既往SARS-CoV-2病史的特征分析

IF 2.4 Q1 PEDIATRICS
Sebastian Felix Nepomuk Bode, Anja Schwender, Monika Toth, Christine Kaeppler-Schorn, Ute Siebeneich, Joachim Freihorst, Ales Janda, Dorit Fabricius
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引用次数: 0

摘要

背景:SARS-CoV-2大流行已在成人人群中引起显著的肺部发病率和死亡率。儿童和青少年通常表现出较轻的症状;然而,他们中有相当比例的人报告即使在轻度SARS-CoV-2感染后也存在持续的肺部症状。功能性呼吸障碍可能是持续性呼吸困难的相关鉴别诊断。本研究旨在了解SARS-CoV-2感染后可能出现的功能性呼吸系统疾病的临床表现和肺功能测试,并了解开始适当治疗后的临床过程。方法:本研究回顾性分析了2022年1月1日至2022年10月31日期间在儿科肺科门诊就诊的所有确诊为SARS-CoV-2感染后出现功能性呼吸障碍的患者。在诊断功能性呼吸障碍时,考虑了临床病史、有关呼吸模式的全面临床检查和肺功能测试(pft)。结果:25例患者(44%为女性),平均年龄(m) = 12.73岁(SD±1.86),在感染后(m = 4.15(±4.24)周发病)表现出明显的功能性呼吸障碍特征。11例患者表现为胸腔优势呼吸伴通气不足,4例患者主要表现为诱导性喉梗阻。其余(n = 10)显示这两种病因重叠。大多数患者肺活量计吸气曲线变平,体体积描记仪残余体积略有升高,但pft值在标准化跑步机运动测试前后均正常。患者被告知病情的良性,并接受了再呼吸训练。所有患者(n = 5)均在3个月内呼吸方式恢复正常。结论:功能性呼吸障碍是青少年持续sars - cov -2后呼吸困难的重要鉴别诊断。结合临床病史、详细的呼吸模式检查和肺功能检查有助于正确诊断这些疾病。安慰和再呼吸训练是治疗的主要内容。临床过程良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2.

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2.

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2.

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2.

Background: The SARS-CoV-2 pandemic has caused significant pulmonary morbidity and mortality in the adult population. Children and adolescents typically show milder symptoms; however, a relevant proportion of them report persistent pulmonary symptoms even after mild SARS-CoV-2 infection. Functional respiratory disorders may be relevant differential diagnoses of persistent dyspnea. This study aims at characterizing functional respiratory disorders that may arise after SARS-CoV-2 infection regarding their clinical presentation and pulmonary function tests as well as gaining insights into the clinical course after initiation of appropriate therapy.

Methods: This study retrospectively identified all patients referred to an outpatient clinic for pediatric pulmonology with functional respiratory disorders manifesting after proven SARS-CoV-2 infection between January 1, 2022, and October 31, 2022. Clinical history, thorough clinical examination regarding breathing patterns, and pulmonary function tests (PFTs) were taken into consideration to diagnose functional respiratory disorders.

Results: Twenty-five patients (44% female) with mean (m) age = 12.73 years (SD ± 1.86) who showed distinctive features of functional respiratory disorders after SARS-CoV-2 infection (onset at m = 4.15 (± 4.24) weeks after infection) were identified. Eleven patients showed thoracic dominant breathing with insufficient ventilation, and 4 patients mainly had symptoms of inducible laryngeal obstruction. The rest (n = 10) showed overlap of these two etiologies. Most patients had a flattened inspiratory curve on spirometry and slightly elevated residual volume on body plethysmography, but values of PFTs were normal before and after standardized treadmill exercise testing. Patients were educated about the benign nature of the condition and were offered rebreathing training. All patients with follow-up (n = 5) showed normalization of the breathing pattern within 3 months.

Conclusions: Functional respiratory disorders are important differential diagnoses in persisting post-SARS-CoV-2 dyspnea in adolescents. A combination of clinical history, detailed examination of breathing patterns, and pulmonary function tests are helpful to correctly diagnose these conditions. Reassurance and rebreathing training are the mainstay of the therapy. The clinical course is favorable.

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