Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany.
Klin Padiatr. 2024 Feb;236(2):139-144. doi: 10.1055/a-2151-2269. Epub 2024 Jan 29.
Exercise induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise induced bronchoconstriction (EIB) and diagnosed via continuous laryngoscopy while exercising (CLE). However, availability of CLE is limited to specialized centres. And without CLE EILO is often misdiagnosed as EIB. Therefore it is essential to carefully preselect potential EILO candidates. Aim of this study was to investigate whether two short questionnaires -Asthma Control Test (ACT) and Dyspnea Index (DI) evaluating upper airway-related dyspnea- can differentiate between EIB and EILO.
Patients with dyspnea while exercising were analysed with an exercise challenge in the cold chamber (ECC) to diagnose EIB in visit 1 (V1), as appropriate a CLE in visit 2 (V2, 4-6 weeks after V1) and ACT and DI in V1 and V2. EIB patients were treated with asthma medication after V1.
Complete dataset of 36 subjects were gathered. The ACT showed lower values in V2 in EILO compared to EIB patients. A lack of improvement in ACT in V2 after asthma medication of EIB patients is suspicious for additional EILO diagnosis. The DI showed higher values in V1 in EILO compared to EIB patients. A score≥30 can predict a positive CLE reaction.
ACT and DI are valuable tools in preselecting CLE candidates to assure timely diagnostic despite limited diagnostic capabilities.
运动诱发的喉阻塞（EILO）是运动性支气管收缩（EIB）的重要鉴别诊断，通过运动时连续喉镜检查（CLE）进行诊断。然而，CLE 的可用性仅限于专门的中心。如果没有 CLE，EILO 通常会被误诊为 EIB。因此，仔细选择潜在的 EILO 候选者至关重要。本研究的目的是探讨两个简短的问卷——哮喘控制测试（ACT）和呼吸困难指数（DI），评估上气道相关呼吸困难——是否可以区分 EIB 和 EILO。
在寒冷室（ECC）中对运动时出现呼吸困难的患者进行运动挑战，以在第 1 次就诊（V1）中诊断 EIB，如果合适，在第 2 次就诊（V2，V1 后 4-6 周）中进行 CLE 和 ACT 和 DI。EIB 患者在 V1 后接受哮喘药物治疗。
共收集了 36 名患者的完整数据集。在 EILO 中，ACT 在 V2 中的值低于 EIB 患者。EIB 患者在哮喘药物治疗后 V2 中 ACT 无改善提示可能存在额外的 EILO 诊断。在 EILO 中，DI 在 V1 中的值高于 EIB 患者。评分≥30 可预测 CLE 反应阳性。
ACT 和 DI 是在选择 CLE 患者时的有价值的工具，可以确保在诊断能力有限的情况下及时进行诊断。
