Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Diagnostics

Background:

• Dysfunctional breathing (DB) is a prevalent condition in children, affecting quality of life and physical functioning.
• DB comprises two key components: breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO), which often co-exist.
• DB symptoms, such as shortness of breath and chest discomfort, are frequently misdiagnosed as asthma.

Purpose of the Study:

• To provide a comprehensive overview of dysfunctional breathing in children.
• To outline diagnostic approaches and algorithms for identifying BPD and ILO.
• To emphasize the importance of a multidisciplinary approach in managing pediatric DB.

Main Methods:

• Expert history taking and physical examination.
• Diagnostic tests including spirometry, breathing pattern analysis, exercise testing, and laryngoscopy.
• Utilization of a proposed diagnostic algorithm to guide test selection and interpretation.

Main Results:

• Patients with DB often exhibit normal spirometry at rest but altered breathing patterns, exacerbated during exercise.
• Pediatric ILO may present with upper airway abnormalities like cobblestoning and exercise-induced stridor.
• DB frequently co-occurs with conditions like asthma, necessitating their prior management for successful DB therapy.

Conclusions:

• A multidisciplinary clinic approach is recommended for diagnosing co-existing BPD and ILO.
• Non-pharmaceutical therapy, tailored by experienced therapists (physiotherapist, SLP, psychologist), is the primary treatment for pediatric DB.
• Individualized treatment plans lead to successful functional recovery and rare recurrence.