For children with exercise-induced respiratory symptoms (EIS), diagnosis at an outpatient clinic often differs from that proposed by the referring physician, according to a study published in Pediatric Pulmonology. Investigators compared the diagnosis proposed by primary care physicians to the final diagnosis from respiratory outpatient clinics where children were referred for EIS. Data were included for 214 children (mean age, 12). The final diagnosis was asthma, extrathoracic dysfunctional breathing (DB), thoracic DB, asthma plus DB, insufficient fitness, chronic cough, and other diagnoses in 54%, 16%, 10%, 11%, 5%, 3%, and 1% of patients, respectively. In 54% of the children, the final diagnosis differed from referral diagnosis. Almost all patients underwent spirometry, body plethysmography, and exhaled nitric oxide measurement; one-third underwent exercise challenge tests; and none underwent laryngoscopy. Of the children with a final diagnosis of asthma, 91% were prescribed inhaled medication; 505 of those with DB were referred for physical therapy. “Extrathoracic and thoracic DB were common diagnoses in children with EIS but had rarely been suspected by the referring physician and were also not well followed up,” the authors write. “Increased awareness, both among primary care physicians and among respiratory specialists of how common DB are in children with EIS, might lead to faster referral to specialized clinics and better treatment.”
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