Bhatia Rajeev, Abu-Hasan Mutasim, Weinberger Miles
Pediatr Ann. 2019 Mar 1;48(3):e121-e127. doi: 10.3928/19382359-20190219-02.
Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, chest wall restrictive abnormalities, cardiac causes, and normal physiologic limitation. When exercise-induced dyspnea is not from asthma, cardiopulmonary exercise testing with reproduction of the patient's dyspnea is the means to identify the other causes. Cardiopulmonary exercise testing monitors oxygen use, carbon-dioxide production, end-tidal pCO (partial pressure of carbon dioxide), and electrocardiogram. Additional components to testing are measurement of blood pH and pCO when symptoms are reproduced, and selective flexible laryngoscopy when upper airway obstruction is observed to specifically identify vocal cord dysfunction or laryngomalacia. This approach is a highly effective means to identify exercise-induced dyspnea that is not caused by asthma. [Pediatr Ann. 2019;48(3):e121-e127.].
儿童和青少年运动诱发的呼吸困难可能由多种原因引起。虽然哮喘是常见原因，但通过使用支气管扩张剂（如沙丁胺醇）进行预处理未能预防运动诱发的哮喘，这表明应考虑其他病因。运动诱发呼吸困难的其他原因包括运动诱发的声带功能障碍、运动诱发的喉软化、运动诱发的过度通气、胸壁限制性异常、心脏原因以及正常生理限制。当运动诱发的呼吸困难并非由哮喘引起时，通过再现患者呼吸困难的心肺运动试验是识别其他原因的方法。心肺运动试验可监测氧气使用、二氧化碳产生、呼气末二氧化碳分压（pCO₂）以及心电图。测试的其他组成部分包括在再现症状时测量血液pH值和pCO₂，以及当观察到上气道阻塞时进行选择性软性喉镜检查，以明确识别声带功能障碍或喉软化。这种方法是识别非哮喘引起的运动诱发呼吸困难的高效手段。[《儿科年鉴》。2019年；48(3):e121 - e127。]
