ORIGINAL ARTICLE

How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren?

M Seear, D Wensley, N West

Department of Respiratory Medicine, Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada

Correspondence to:
Dr M Seear
Children’s & Women’s Health Centre of BC, 4480 Oak Street, Room 1C42, Vancouver, British Columbia, V6H 3V4, Canada; mseear{at}cw.bc.ca

Background: Limited access to exercise testing facilities means that the diagnosis of exercise induced asthma (EIA) is mainly based on self-reported respiratory symptoms. This is open to error since the correlation between exercise related symptoms and subsequent exercise testing has been shown to be poor.

Aim: To study the accuracy of clinically diagnosed EIA among Vancouver schoolchildren.

Methods: Fifty two children referred for investigation of poorly controlled EIA were studied. Following a careful history and physical examination, children performed pulmonary function tests before, then 5 and 15 minutes after a standardised treadmill exercise test. Based on overall assessment, a diagnostic explanation for each child’s respiratory complaints was provided as far as possible.

Results: Only eight children (15.4%) fulfilled diagnostic criteria for EIA (fall in FEV₁ 10%). Of the remainder: 12 (23.1%) were unfit, 14 (26.9%) had vocal cord dysfunction/sigh dyspnoea, 7 (13.5%) had a habit cough, and 11 (21.1%) had no abnormalities on clinical or laboratory testing, so were given no diagnosis. Initial reported symptoms of wheeze or cough often changed significantly following a careful history, particularly among the eight elite athletes. The final complaint was sometimes not respiratory, and, in a few cases, was not even associated with exercise.

Conclusions: The clinical diagnosis of EIA is inaccurate among Vancouver schoolchildren, principally due to the unreliability of their initial exercise related complaints. Symptom exaggeration, familiarity with medical jargon, and psychogenic complaints are all common. A careful history is essential in this population before basing any diagnosis on self-reported respiratory symptoms.

Abbreviations: BMI, body mass index; EIA, exercise induced asthma; FEF_25–75,; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; PEFR, peak expiratory flow rate; VCD, vocal cord dysfunction

Keywords: asthma; diagnostic error; respiratory symptoms; exercise

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