Fainardi Valentina, Grandinetti Roberto, Mussi Nicole, Rossi Arianna, Masetti Marco, Giudice Antonella, Pilloni Simone, Deolmi Michela, Ramundo Greta, Alboresi Stefano, Bergamini Barbara Maria, Bergomi Andrea, Bersini Maria Teresa, Biserna Loretta, Bottau Paolo, Corinaldesi Elena, Crestani Sara, De Paulis Nicoletta, Fontijn Simone, Guidi Battista, Lombardi Francesca, Loretano Lanfranco, Gallo Paola, Guerrera Fabio, Mari Sandra, Marotti Francesca, Miniaci Angela, Parpanesi Marco, Pastorelli Silvia, Piccorossi Alessandra, Dascola Carlotta Povesi, Reggiani Lamberto, Sacchetti Roberto, Scialpi Valeria, Vaienti Francesca, Venturelli Cristina, Vignutelli Lucia, Ricci Giampaolo, Caffarelli Carlo, Esposito Susanna
Department of Medicine and Surgery, Pediatric Clinic, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
Pediatric Clinic, Az. Ospedaliero-Universitaria Di Parma, Parma, Italy.
Respir Res. 2024 Dec 27;25(1):445. doi: 10.1186/s12931-024-03078-5.
Exercise-induced bronchoconstriction (EIB) is common in children with asthma but can be present also in children without asthma, especially athletes. Differential diagnosis includes several conditions such as exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history, clinical examination and specific tests are mandatory to exclude alternative diagnoses. Given the high prevalence of EIB in children and its potential impact on health, sport performance, and daily levels of physical activity, health care professionals should be aware of this condition and able to provide a specific work-up for its identification. The aims of the present study were: (a) to assess the agreement among hospital pediatricians and primary care pediatricians of Emilia-Romagna Region (Italy) about the management of EIB in children and (b) formulate statements in a consensus document to help clinicians in daily clinical practice.
According to Delphi method, a panel of specialists scored 40 statements that were then revised and discussed during online meetings to reach full consensus. Statements were then formulated.
To obtain full consensus, the questionnaire was administered in two rounds after full discussion of the uncertain topics on the basis of the latest evidence on EIB published over the last 10 years. Despite an overall agreement on EIB management, some gaps emerged in the sections dedicated to diagnosis and treatment. Nine summary statements on definition, pathogenesis, diagnostic work-up, treatment, and follow-up were eventually formulated.
This study describes the knowledge of EIB in a group of pediatricians and highlights gaps and uncertainties in diagnosis and treatment. The creation of statements shared by the specialists of the same area may improve the management of EIB in children. However, more research and evidence are needed to better clarify the best treatment and to standardize the best diagnostic protocol limiting useless examinations but at the same time assuring the best management.
运动诱发的支气管收缩（EIB）在哮喘儿童中很常见，但在无哮喘儿童中也可能出现，尤其是运动员。鉴别诊断包括多种情况，如运动诱发的喉梗阻（EILO）、心脏病或身体机能减退。详细的病史、临床检查和特定检查对于排除其他诊断至关重要。鉴于EIB在儿童中的高患病率及其对健康、运动表现和日常身体活动水平的潜在影响，医疗保健专业人员应了解这种情况，并能够提供特定的检查流程以进行识别。本研究的目的是：（a）评估意大利艾米利亚 - 罗马涅地区的医院儿科医生和初级保健儿科医生在儿童EIB管理方面的一致性；（b）在一份共识文件中制定声明，以帮助临床医生进行日常临床实践。
根据德尔菲法，一组专家对40条声明进行评分，然后在在线会议期间进行修订和讨论以达成完全共识。随后制定声明。
为达成完全共识，在根据过去10年发表的关于EIB的最新证据对不确定主题进行充分讨论后，问卷进行了两轮发放。尽管在EIB管理方面总体达成了一致，但在诊断和治疗部分仍出现了一些差距。最终制定了关于定义、发病机制、诊断检查、治疗和随访的九条总结声明。
本研究描述了一组儿科医生对EIB的认识，并突出了诊断和治疗方面的差距与不确定性。同一领域专家共同分享声明可能会改善儿童EIB的管理。然而，需要更多的研究和证据来更好地阐明最佳治疗方法，并规范最佳诊断方案，减少无用检查，同时确保最佳管理。
