Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Arch Dis Child Educ Pract Ed. 2021 Apr;106(2):66-70. doi: 10.1136/archdischild-2020-319454. Epub 2020 Oct 19.
Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered 'rare' though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.
运动性呼吸困难是儿童和青少年常见的主诉症状，也是全科医生常见的就诊原因。运动性呼吸困难最常见的原因是运动诱发的支气管收缩（EIB），但也有其他几个原因，包括过度通气综合征、与正常运动受限相关的呼吸困难以及运动诱发的喉阻塞（EILO）。EILO 的症状包括喘鸣、喉咙发紧和吸气困难。如果这些症状被误认为是 EIB，儿童将接受哮喘治疗。EILO 的潜在机制包括在高强度运动期间关闭喉部，这会导致气流减少和呼吸困难。这种现象通常与心理压力有关。从历史上看，EILO 的诊断被认为是“罕见的”，尽管这可能反映了认识不足。通过喉镜进行直接视觉观察是诊断 EILO 的金标准；然而，即使在专门的中心，这种方法也很少使用。然而，通常可以通过识别特征性的临床模式来做出诊断。在这里，我们为确定 EILO 的适当检查提供了建议，并提出了治疗建议。
