Are Questionnaires Helpful To Predict Exercise-Induced Bronchoconstriction (EIB) And Exercise-Induced Laryngeal Obstruction (EILO)?

Abstract

Objective Exercise induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise induced bronchoconstriction (EIB) and diagnosed via continuous laryngoscopy while exercising (CLE). However, availability of CLE is limited to specialized centres. And without CLE EILO is often misdiagnosed as EIB. Therefore it is essential to carefully preselect potential EILO candidates. Aim of this study was to investigate whether two short questionnaires -Asthma Control Test (ACT) and Dyspnea Index (DI) evaluating upper airway-related dyspnea- can differentiate between EIB and EILO.

Methods Patients with dyspnea while exercising were analysed with an exercise challenge in the cold chamber (ECC) to diagnose EIB in visit 1 (V1), as appropriate a CLE in visit 2 (V2, 4–6 weeks after V1) and ACT and DI in V1 and V2. EIB patients were treated with asthma medication after V1.

Results Complete dataset of 36 subjects were gathered. The ACT showed lower values in V2 in EILO compared to EIB patients. A lack of improvement in ACT in V2 after asthma medication of EIB patients is suspicious for additional EILO diagnosis. The DI showed higher values in V1 in EILO compared to EIB patients. A score≥30 can predict a positive CLE reaction.

Conclusion ACT and DI are valuable tools in preselecting CLE candidates to assure timely diagnostic despite limited diagnostic capabilities.

Zusammenfassung

Hintergrund Belastungsinduzierte Larynxobstruktion (EILO) ist eine wichtige Differentialdiagnose zur belastungsinduzierten Bronchokonstriktion (EIB) und wird mittels kontinuierlicher Laryngoskopie unter Belastung (CLE) diagnostiziert. Die Verfügbarkeit der CLE ist jedoch auf spezialisierte Zentren limitiert und ohne CLE wird EILO häufig als EIB fehldiagnostiziert. Deshalb ist eine gute Vorauswahl potentieller EILO Kandidaten essentiell. Das Ziel der Studie war die Analyse ob zwei kurze Fragebögen – Asthma Control Test (ACT) und Dyspnea Index (DI) der obere Atemwegsdyspnoe evaluiert – zwischen EIB und EILO differenzieren können.

Methoden Patienten mit belastungsinduzierter Dyspnoe wurden mittels Kältelaufbelastung (ECC) in Visite 1 (V1), wenn indiziert einer CLE in Visite 2 (V2, 4–6 Wochen nach V1) sowie ACT und DI in V1 und V2 untersucht. EIB Patienten erhielten nach V1 eine Asthmatherapie.

Ergebnisse Vollständige Datensätze zu 36 Patienten wurden erhoben. Der ACT zeigte in V2 niedrigere Werte in EILO als in EIB Patienten. Eine fehlende Verbesserung des ACT in V2 nach Asthmatherapie der EIB Patienten ist hinweisend auf eine zusätzliche EILO Diagnose. Der DI zeigte in V1 höhere Werte in EILO als in EIB Patienten. Ein Score≥30 sagte eine EILO-Reaktion in der CLE vorher.

Schlussfolgerung ACT und DI sind wertvolle Tests um CLE Kandidaten zu selektieren und so zu gewährleisten, dass diese Patienten trotz begrenzter Diagnostikplätze zeitnah abgeklärt werden können.

Key words

exercise induced bronchoconstriction (eib) - exercise induced laryngeal obstruction (eilo) - Asthma Control Test (act) - Dyspnea Index (di)

Schlüsselwörter

Belastungsinduzierte Bronchokonstriktion (EIB) - belastungsinduzierte Larynxobstruktion (EILO) - Asthmakontrolltest (ACT) - Dyspnea Index (DI)

Publication History

Article published online:
29 January 2024

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