#AskToExpert: this month we talk about ... EXERCISE-INDUCED ASTHMA
Professor Attilio Turchetta, head of the Sports Medicine Unit of the Ospedale Pediatrico Bambino Gesù of Rome answers our questions to clarify the doubts concerning the topic of this month.
1) Q: In most centers there is no possibility to perform a complete cardio-pulmonary test to study exercise-induced symptoms and therefore the only test performed is a spirometry evaluation before and after exercise. Do you believe that this method is dangerous? How much do you think it is necessary to carry out an ECG before performing this test? Among the indirect stimulus tests, which one is considered to be the most safe from a cardiological point of view?
A: If we are talking about cardiac safety, the stress test for broncostimulation is safe. It is a sub-maximal test (the heart rate should be around 80% of the maximal theoretical for the age) and of short duration (6 minutes). The doctor is always present during the test and can stop the test at any time. Having an ECG could be useful, and if the child plays sport, he has probably done it before. So I do not think it is necessary or useful to make a safety ranking between the tests.
2) Q: Do you think it is a good practice to perform premedication with salbutamol in people who have only dyspnea and / or exercise cough, or would it be better to establish a therapy with inhaled steroids?
A: If the main or only symptom is exercise-induced asthma only premedication with salbutamol is required.
3) Q: The prevalence of asthma among the obese population is increasing. But in literature it is still necessary to clarify whether there is a real increase in prevalence of asthma or if, increasing the prevalence of obesity in the pediatric population, the rising symptoms are correlated to a poor training. How much can bronchial hyperreactivity tests help us to understand if an obese child with respiratory symptoms is really asthmatic?
A: The difference in obese children is that breathlessness is very frequent and practically never associated with coughing or wheezing, which are the main symptoms of exercise-induced asthma. If you can not make a clinical distinction (for example an obese, allergic child) a broncostimulation test will allow us to make a correct diagnosis.
4) Q: What are the signs and/or symptoms that can make us suspect a heart disease in a child who has respiratory symptoms with the exercise? Are there any anamnestic findings (time of onset, severity, repeatability ...) or clinical useful to differentiate exercise-induced asthma from other diseases?
A: Fortunately, congenital cardiac diseases now recognize a very early diagnosis, often at prenatal age. The presence of suspicious heart murmurs or poorly present femoral wrists (a complete examination before the stress test is always necessary) can guide the need to perform a cardiological study.
5) Q: What helps us to distinguish exercise.induced asthma from vocal cord dysfunction (VCD)?
A: The story of a child with excruciating strain, often accompanied by coughing leads to the dysfunction of the vocal cords already from the anamnesis. If a stress test is performed and the symptom is present, the immediate execution of a spirometry will allow to suspect the diagnosis of VCD, thanks to the particular characteristics of the inspiratory and expiratory curve.