运动诱导性呼吸问题患儿的报告症状可区分诊断：来自瑞士儿科气道队列（SPAC）的研究结果。

Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC).

机构信息

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.

出版信息

J Allergy Clin Immunol Pract. 2021 Feb;9(2):881-889.e3. doi: 10.1016/j.jaip.2020.09.012. Epub 2020 Sep 19.

DOI:10.1016/j.jaip.2020.09.012

PMID:32961313

Abstract

BACKGROUND

Exercise-induced breathing problems with similar clinical presentations can have different etiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult.

OBJECTIVE

We studied which parent-reported, exercise-induced symptoms can help distinguish diagnoses in children seen in respiratory outpatient clinics.

METHODS

This study was nested in the Swiss Paediatric Airway Cohort, an observational study of children aged 0 to 17 years referred to pediatric respiratory outpatient clinics in Switzerland. We studied children aged 6 to 17 years and compared information on exercise-induced symptoms from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyze whether parent-reported symptoms differed between diagnoses (asthma as base).

RESULTS

Among 1109 children, exercise-induced symptoms were reported for 732 (66%) (mean age: 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnea best distinguished thoracic DB (relative risk ratio [RRR]: 5.4, 95% confidence interval [CI]: 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR: 2.4, 95% CI: 1.3-6.2) and asthma plus DB (RRR: 1.8, 95% CI: 0.9-3.4) from asthma only. Late onset of symptoms was less common for extrathoracic DB (RRR: 0.1, 95% CI: 0.03-0.5) and thoracic DB (RRR: 0.4, 95% CI: 0.1-1.2) compared with asthma. Localization of dyspnea (throat vs chest) differed between extrathoracic DB (RRR: 2.3, 95% CI: 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses.

CONCLUSION

Parent-reported symptoms help distinguish different diagnoses in children with exercise-induced symptoms. This highlights the importance of physicians obtaining detailed patient histories.

摘要

背景

具有相似临床表现的运动引起的呼吸问题可能有不同的病因。这使得区分常见的诊断变得困难，如哮喘、胸外和胸内呼吸功能障碍（DB）、体能不足和慢性咳嗽。

目的

我们研究了哪些父母报告的、与运动相关的症状可以帮助区分在呼吸门诊就诊的儿童的诊断。

方法

这项研究是嵌套在瑞士小儿气道队列研究中的，这是一项对瑞士儿科呼吸门诊就诊的 0 至 17 岁儿童的观察性研究。我们研究了 6 至 17 岁的儿童，并比较了父母填写的问卷中关于运动诱发症状的信息，这些信息来自于不同诊断的儿童。我们使用多项回归分析来分析父母报告的症状是否因诊断而异（哮喘作为基础）。

结果

在 1109 名儿童中，有 732 名（66%）儿童报告了运动诱发的症状（平均年龄：11 岁，732 名中有 318 名[43%]为女性）。在这些症状中，呼吸困难最能区分胸内 DB（相对风险比[RRR]：5.4，95%置信区间[CI]：1.3-22）与哮喘。在运动触发因素中，游泳最能区分胸内 DB（RRR：2.4，95% CI：1.3-6.2）和哮喘加 DB（RRR：1.8，95% CI：0.9-3.4）与单纯哮喘。与哮喘相比，胸外 DB（RRR：0.1，95% CI：0.03-0.5）和胸内 DB（RRR：0.4，95% CI：0.1-1.2）的症状出现较晚。呼吸困难的定位（喉咙与胸部）在胸外 DB（RRR：2.3，95% CI：0.9-5.8）和哮喘之间有所不同。报告的呼吸阶段（吸气或呼气）并不能帮助区分诊断。