Carta Revisado por pares

Etiology of exercise-induced dyspnea: Not just exercise-induced asthma or vocal cord dysfunction

2007; Elsevier BV; Volume: 121; Issue: 1 Linguagem: Inglês

10.1016/j.jaci.2007.08.062

ISSN

1097-6825

Autores

Miles Weinberger,

Tópico(s)

Allergic Rhinitis and Sensitization

Resumo

To the Editor:In considering the differential diagnosis of exercise-induced asthma, The Work Group Report on exercise-induced asthma1Weiler J.M. Bonini S. Coifman R. Craig T. Delgado L. Capão-Filipe M. et al.American Academy of Allergy, Asthma & Immunology Work Group Report: exercise-induced asthma.J Allergy Clin Immunol. 2007; 119: 1349-1358Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar failed to consider that the differential diagnosis of exercise-induced dyspnea includes more than vocal cord dysfunction and the less common entities of exercise-induced laryngomalacia and exercise-induced anaphylaxis. In a recent report, only 8 of 52 children referred to a pediatric pulmonologist with a diagnosis of difficult-to-manage exercise-induced asthma actually had evidence for exercise-induced bronchospasm.2Seear M. Wensley D. West N. How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren?.Arch Dis Child. 2005; 90: 898-902Crossref PubMed Scopus (115) Google ScholarIn a publication from the Pediatric Allergy and Pulmonary Division at the University of Iowa, 98 of 142 patients referred to our clinic for exercise-induced dyspnea had their symptoms attributed to asthma by the referring physician. Among the 117 for whom symptoms could be reproduced during treadmill exercise testing, only 11 had exercise-induced asthma. Seventy-four demonstrated only normal physiologic exercise limitation, 48 of these 74 with normal to high cardiovascular conditioning and 26 with poor conditioning.3Abu-Hasan M. Tannous B. Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what?.Ann Allergy Asthma Immunol. 2005; 94: 366-371Abstract Full Text PDF PubMed Scopus (162) Google Scholar Other diagnoses associated with reproduced exercise-induced dyspnea included restrictive abnormalities in 15 patients, vocal cord dysfunction in 13 patients, exercise-indued laryngomalacia in 2 patients (1 of whom had unilateral vocal cord paralysis), primary hyperventilation during exercise in 1 patient, and supraventricular tachycardia in 1 patient.Our data indicated that exercise-induced asthma is unlikely to be the etiology of exercise-induced dyspnea in the absence of other current or past symptoms consistent with asthma or the failure for albuterol to block exercise-induced dyspnea when baseline pulmonary function is normal. Exercise testing that monitors cardiopulmonary physiology while symptoms are reproduced provides the most comprehensive means of identifying the cause of exercise-induced dyspnea. Identifying the cause is essential for treating and/or counseling the patient.3Abu-Hasan M. Tannous B. Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what?.Ann Allergy Asthma Immunol. 2005; 94: 366-371Abstract Full Text PDF PubMed Scopus (162) Google Scholar To the Editor: In considering the differential diagnosis of exercise-induced asthma, The Work Group Report on exercise-induced asthma1Weiler J.M. Bonini S. Coifman R. Craig T. Delgado L. Capão-Filipe M. et al.American Academy of Allergy, Asthma & Immunology Work Group Report: exercise-induced asthma.J Allergy Clin Immunol. 2007; 119: 1349-1358Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar failed to consider that the differential diagnosis of exercise-induced dyspnea includes more than vocal cord dysfunction and the less common entities of exercise-induced laryngomalacia and exercise-induced anaphylaxis. In a recent report, only 8 of 52 children referred to a pediatric pulmonologist with a diagnosis of difficult-to-manage exercise-induced asthma actually had evidence for exercise-induced bronchospasm.2Seear M. Wensley D. West N. How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren?.Arch Dis Child. 2005; 90: 898-902Crossref PubMed Scopus (115) Google Scholar In a publication from the Pediatric Allergy and Pulmonary Division at the University of Iowa, 98 of 142 patients referred to our clinic for exercise-induced dyspnea had their symptoms attributed to asthma by the referring physician. Among the 117 for whom symptoms could be reproduced during treadmill exercise testing, only 11 had exercise-induced asthma. Seventy-four demonstrated only normal physiologic exercise limitation, 48 of these 74 with normal to high cardiovascular conditioning and 26 with poor conditioning.3Abu-Hasan M. Tannous B. Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what?.Ann Allergy Asthma Immunol. 2005; 94: 366-371Abstract Full Text PDF PubMed Scopus (162) Google Scholar Other diagnoses associated with reproduced exercise-induced dyspnea included restrictive abnormalities in 15 patients, vocal cord dysfunction in 13 patients, exercise-indued laryngomalacia in 2 patients (1 of whom had unilateral vocal cord paralysis), primary hyperventilation during exercise in 1 patient, and supraventricular tachycardia in 1 patient. Our data indicated that exercise-induced asthma is unlikely to be the etiology of exercise-induced dyspnea in the absence of other current or past symptoms consistent with asthma or the failure for albuterol to block exercise-induced dyspnea when baseline pulmonary function is normal. Exercise testing that monitors cardiopulmonary physiology while symptoms are reproduced provides the most comprehensive means of identifying the cause of exercise-induced dyspnea. Identifying the cause is essential for treating and/or counseling the patient.3Abu-Hasan M. Tannous B. Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what?.Ann Allergy Asthma Immunol. 2005; 94: 366-371Abstract Full Text PDF PubMed Scopus (162) Google Scholar

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