Efficient Use of Simple Exercise-Induced Bronchoconstriction Challenge Testing in Pediatric Exercise-Induced Dyspnea

Area of Science:

• Pediatric Pulmonology
• Exercise Physiology
• Diagnostic Testing

Background:

• Exercise-induced bronchoconstriction (EIB) is commonly evaluated in children with exercise-induced dyspnea.
• The diagnostic utility of simple EIB challenge tests for identifying the cause of dyspnea in pediatric populations is not well-established.

Purpose of the Study:

• To assess the efficiency of a simple EIB challenge test in determining the cause of exercise-induced dyspnea in pediatric patients referred to a tertiary center.
• To evaluate the effectiveness of current diagnostic methods for exercise-induced dyspnea in children.

Main Methods:

• Retrospective chart review of exercise tests conducted between March 2011 and March 2016.
• Exclusion of pediatric patients with chronic conditions like cystic fibrosis or cardiac abnormalities.
• Collection of demographic data, asthma diagnosis, presumptive diagnosis, symptoms, albuterol use, spirometry, and EIB challenge test results; chi-square test used for analysis.

Main Results:

• Only 19% of 164 enrolled pediatric subjects (ages 6-20) showed evidence of EIB.
• No significant associations were found between EIB status and gender, symptoms, asthma diagnosis, or albuterol use (P > .05).
• Subjects without asthma were 2.8 times more likely to have a negative EIB test, with approximately 85% of these tests being negative.

Conclusions:

• Simple EIB challenge testing is often inefficient for diagnosing the cause of exercise-induced dyspnea in pediatric patients without asthma.
• Cardiopulmonary exercise testing may offer a more useful and cost-effective approach to investigate dyspnea causes, including EIB, in this population.