title: Cross-sectional assessment of exertional dyspnea in otherwise healthy children.
abstract: OBJECTIVE
  Exertional dyspnea during sport at school in children with asthma or in otherwise healthy children is commonly attributed to exercise-induced asthma (EIA), but when a short-acting beta agonist (SABA) trial fails to improve symptoms the physician is often at a loose end.
  
  
  METHODS
  The aims were to prospectively assess the causes of exertional dyspnea in children/adolescents with or without asthma using a cardiopulmonary exercise test while receiving a SABA and to assess the effects of standardized breathing/reassurance therapy.
  
  
  RESULTS
  Seventy-nine patients (12.2 ± 2.3 years, 41 girls, 49 with previously diagnosed asthma) with dyspnea unresponsive to SABA were prospectively included. Exercise test outcomes depicted normal or subnormal performance with normal ventilatory demand and capacity in 53/79 children (67%) defining a physiological response. The remaining 26 children had altered capacity (resistant EIA [n = 17, 9 with previous asthma diagnosis], vocal cord dysfunction [n = 2]) and/or increased demand (alveolar hyperventilation [n = 3], poor conditioning [n = 7]). Forty-two children who had similar characteristics than the remaining 37 children underwent the two sessions of standardized reassurance therapy. They all demonstrated an improvement that was rated "large." The degree of improvement correlated with % predicted peak V'O2 (r = -0.37, P = 0.015) and peak oxygen pulse (r = -0.45, P = 0.003), whatever the underlying dyspnea cause. It suggested a higher benefit in those with poorer conditioning condition.
  
  
  CONCLUSIONS
  The most frequent finding in children/adolescents with mild exertional dyspnea unresponsive to preventive SABA is a physiological response to exercise, and standardized reassurance afforded early clinical improvement, irrespective of the dyspnea cause.
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie-Clinique de la Dyspnée, Paris, France; Cabinet La Berma, Antony, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mahut
authors.forename: Deborah
authors.initials: D
authors.lastname: Fuchs-Climent
authors.forename: Laurent
authors.initials: L
authors.lastname: Plantier
authors.forename: Chantal
authors.initials: C
authors.lastname: Karila
authors.forename: Luc
authors.initials: L
authors.lastname: Refabert
authors.forename: Brigitte
authors.initials: B
authors.lastname: Chevalier-Bidaud
authors.forename: Nicole
authors.initials: N
authors.lastname: Beydon
authors.forename: Claudine
authors.initials: C
authors.lastname: Peiffer
authors.forename: Christophe
authors.initials: C
authors.lastname: Delclaux
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists; D001249:Asthma / Q000150:complications / Q000175:diagnosis; D001250:Asthma, Exercise-Induced / Q000150:complications* / Q000175:diagnosis; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006486:Hemosiderosis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis; D008297:Male; D005082:Physical Exertion / Q000502:physiology*; D010809:Physical Fitness; D011446:Prospective Studies; D014797:Vital Capacity; D064706:Vocal Cord Dysfunction / Q000150:complications* / Q000175:diagnosis; D000097545:Hemosiderosis, Pulmonary
chemical_list: D000318:Adrenergic beta-Agonists
keywords: adolescent; asthma; child; dyspnea; exercise