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Pediatric Wheezing: If Not Asthma, Then What is It?
Date:5/30/2008

eeze (expiratory noise) or have stridor (inspiratory noise). However, many non-asthmatics may present asthmatic symptoms triggered by exercise (exercise-induced bronchospasm).

In a recent study, researchers from the University of Iowa examined 142 pediatric patients referred for exercise-induced dypsnea, 98 of whom had been presumed to have EIA by their primary care physician. Upon further examination, only 11 patients (9 percent) actually had EIA. Seventy-four (63 percent) patients were exercising too hard or were not properly conditioned for their activity level. Other diagnoses included restrictive abnormalities (13 percent), and vocal cord dysfunction (11 percent), among others.

Ouellette and Pleacher detailed eight common non-asthmatic conditions during the session. The conditions (listed in alphabetical order) are:

1. Deconditioning -- when the patient is not in shape for the engaged

physical activity

2. Exercise-Induced Anaphylaxis -- allergic reaction to exercise

3. Foreign Body Aspiration -- inhaled items

4. Gastroesophageal reflux disease (GERD) -- a digestive disorder of the

lower esophageal sphincter

5. Hyperventilation -- excessive breathing

6. Psychogenic Cough -- a dry, non-productive cough associated with

emotional or psychological problems

7. Tracheomalacia -- collapse of the airway

8. Vocal Cord Dysfunction -- closing of vocal cords when breathing in

Ouellette explains that replicating the situation and symptoms is important for an accurate diagnosis. "For example, if a patient is a swimmer, you should test them at the pool. If they are a hockey player, you should test them in an ice-rink where the environmental elements are consistent."

While a pulmonologist, allergist or ear, nose and throat specialist are perfectly qualified to treat these patients, these professionals may miss an important explanation for the symptoms based on athletic
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SOURCE American College of Sports Medicine
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