Evaluating Children and Adolescents with Suspected Exercise Induced Asthma: Real Life Data

Abstract

Objective Exercise-induced bronchoconstriction (EIB) occurs frequently in children and adolescents and may be a sign of insufficient asthma control. EIB is often evaluated by respiratory symptoms, spirometry, eNO measurement and methacholine testing (MCT) instead of time consuming exercise test. Aim of this study was to analyse the amount of patients for which an exercise challenge in a cold chamber (ECC) was needed for a clear EIB diagnosis, to characterize EIB phenotypes and the incidence of exercise induced laryngeal obstruction (EILO) in a large cohort of patients with EIB.

Methods A retrospective analysis was performed in 595 children and adolescents (mean age 12.1 years) with suspected EIB from January 2014 to December 2018. Complete data sets of skin prick test, spirometry, eNO and MCT were available from 336 patients.

Results An ECC to confirm the EIB diagnosis was performed in 125 (37.2%) of patients. Three EIB phenotypes were detected: group 1: EIB without allergic sensitization (n=159); group 2: EIB with other than house dust mite (HDM) sensitization (n=87) and group 3: EIB with HDM sensitization (n=90). MCT and eNO showed significant differences between the subgroups: An eNO>46 ppb and/or a MCT<0.1 mg was found in 23.9% vs. 50.6% vs. 57.8% in group 1–3, respectively. Significantly more patients suffered from EILO in group 1 compared to group 2 and 3 (n=13 vs. n=1).

Conclusion EIB without sensitization is as often as EIB with sensitization. In patients without sensitization, EILO has to be considered as a possible cause of symptoms during exercise.

Zusammenfassung

Einleitung Belastungsinduzierte Bronchokonstriktion (EIB) tritt häufig bei Kindern und Jugendlichen auf und kann Anzeichen für unzureichende Asthmakontrolle sein. Häufig wird die Diagnose EIB anhand der Atemwegssymptome, Spirometrie, eNO-Messung und Methacholin-Tests (MCT) gestellt anstatt mittels zeitaufwändigem Belastungstest. Ziel dieser Studie war es zu ermitteln bei wie vielen Patienten eine Kältelaufbelastung (ECC) zur Bestätigung der Diagnose EIB benötigt wurde, die EIB-Phänotypen zu charakterisieren und die Anzahl der Patienten mit belastungsinduzierter Larynxobstruktion (EILO) in einer großen Kohorte von Patienten mit Verdacht auf EIB zu ermitteln.

Zielsetzung Retrospektive Analyse von 595 Patient*innen mit Verdacht auf EIB (Durchschnittsalter 12,1 Jahre) von Januar 2014 bis Dezember 2018. Von 336 Patient*innen standen vollständige Datensätze zu Haut-Prick-Tests, Spirometrie, eNO und MCT zur Verfügung.

Ergebnisse Bei 125 (37,2%) der Patient*innen wurde eine ECC zum Nachweis einer EIB benötigt. Drei EIB-Phänotypen wurden herausgearbeitet: Gruppe 1: EIB ohne Sensibilisierung (n=159); Gruppe 2: EIB mit sonstiger Sensibilisierung (n=87) und Gruppe 3: EIB mit Hausstaubmilbensensibilisierung (n=90). MCT und eNO zeigten signifikante Unterschiede zwischen den drei Gruppen: Ein eNO>46 ppb und/oder ein MCT<0,1 mg wurde bei 23,9% vs. 50,6% vs. 57,8% in den Patientengruppe 1–3 gefunden. EILO war bei Patientengruppe 1 signifikant häufiger als in Gruppe 2 und 3 (n=13 vs. n=1).

Schlussfolgerung EIB ohne Sensibilisierung ist ebenso häufig wie EIB mit Sensibilisierung. Bei Patient*innen ohne Sensibilisierung sollte eine EILO als mögliche Ursache der Beschwerden bei körperlicher Belastung in Betracht gezogen werden.

Key words

Exercise-induced bronchoconstriction (EIB) - exercise induced laryngeal obstruction (EILO) - house dust mite allergy (HDM) - exhaled nitric oxide (eNO) - exercise challenge in a cold chamber (ECC) - continuous laryngoscopy while exercising (CLE)

Schlüsselwörter

Belastungsinduziertes Asthma (EIB) - Belastungsinduzierte Larynxobstruktion (EILO) - Hausstaubmilbenallergie (HDM) - exhaliertes Stickstoffmonoxid (eNO) - Laufbelastung in einer Kältekammer (ECC) - kontinuierliche Videolaryngoskopie unter Belastung (CLE)published online 2022

Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022

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