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Exercise-induced respiratory symptoms not due to asthma
Chetan A Pandit1, Eugenie Batterby, Peter Van Asperen
1Department Respiratory Medicine, The Children's Hospital at Westmead, Westmead Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Journal of Paediatrics and Child Health
|November 5, 2011
Summary
Exercise can reveal hidden diagnoses like stridor from double aortic arch or vocal cord dysfunction, even when initially mistaken for asthma. A detailed history and lack of response to asthma treatment are key to identifying these conditions.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Diagnostic Challenges
Background:
- Exercise-induced symptoms are often initially attributed to asthma.
- Misdiagnosis can lead to prolonged, ineffective treatment and persistent exercise limitation.
- Conditions like stridor and vocal cord dysfunction can mimic exercise-induced asthma.
Purpose of the Study:
- To highlight the importance of considering alternative diagnoses in patients with exercise-induced respiratory symptoms.
- To emphasize the diagnostic value of detailed patient history, including during exercise.
- To underscore the significance of treatment response in differentiating conditions.
Main Methods:
- Case report analysis of two pediatric patients with exercise-induced symptoms.
- Detailed clinical history taking, focusing on symptom characteristics during physical exertion.
- Evaluation of response to standard asthma treatments, specifically bronchodilators.
Main Results:
- An 8-year-old boy with presumed asthma was diagnosed with exercise-induced stridor due to a double aortic arch compressing the trachea.
- A 13-year-old boy presented with exercise-induced stridor, diagnosed as vocal cord dysfunction, initially treated as exercise-induced wheeze.
- Neither patient responded to bronchodilator therapy, prompting further investigation.
Conclusions:
- Thorough patient history, including symptom specifics during exercise, is crucial for accurate diagnosis.
- Lack of response to bronchodilators in the absence of typical asthma signs warrants consideration of alternative diagnoses.
- Conditions like double aortic arch and vocal cord dysfunction should be considered in the differential diagnosis of exercise-induced respiratory symptoms.
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