Reversible peripheral airway obstruction and lung hyperinflation in children presenting with dyspnea and exercise intolerance after COVID-19 infection

Rabinovitch, Nathan; Nevid, Michael Z.; Lomas, Chad; Covar, Ronina; Levy, Hara; Leung, Donald Y.M.

doi:10.1016/j.jaip.2022.07.038

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…Functional respiratory disorders commonly emerge after mild SARS-CoV-2 infections [ 21 ]. Spirometry and body plethysmography typically show no clear pattern in functional respiratory disorders [ 27 ], but increased RV and normal FEV-1 have been reported in other pediatric studies in some forms of functional respiratory disorders [ 17 ]. Motiejunaite et al reported on hyperventilation on incremental exercise testing in adults [ 19 ], who mostly had been treated as inpatients during acute SARS-CoV-2 infection, and 18% had required mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…No standardized tests as questionnaires or hyperventilation tests were applied but thorough clinical examination of breathing patterns while resting and while exercising, as well as after exercising by experienced pediatric pulmologists. Some of the patients had pre-diagnosed asthma which has been reported in a significant number of children with post-acute SARS-CoV-2 respiratory symptoms [ 17 ]. No PFT after treadmill exercise showed hints for bronchial obstruction or increased airway resistance; therefore, at least in our cohort, asthma seems to be not causal for the symptoms reported.…”

Section: Discussionmentioning

confidence: 99%

“…There is also evidence that some patients might show postinfectious bronchial hyperreactivity, even months after SARS-CoV-2 infection [ 4 ]. These subjects typically present with dry cough, worsened on exercise, and might benefit from inhaled corticosteroids [ 17 ]. Additionally preexistent asthma might worsen and only be diagnosed as symptoms emerge after airway infection [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…These subjects typically present with dry cough, worsened on exercise, and might benefit from inhaled corticosteroids [ 17 ]. Additionally preexistent asthma might worsen and only be diagnosed as symptoms emerge after airway infection [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2

Bode,

Schwender,

Toth

et al. 2023

Mol Cell Pediatr

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Background The SARS-CoV-2 pandemic has caused significant pulmonary morbidity and mortality in the adult population. Children and adolescents typically show milder symptoms; however, a relevant proportion of them report persistent pulmonary symptoms even after mild SARS-CoV-2 infection. Functional respiratory disorders may be relevant differential diagnoses of persistent dyspnea. This study aims at characterizing functional respiratory disorders that may arise after SARS-CoV-2 infection regarding their clinical presentation and pulmonary function tests as well as gaining insights into the clinical course after initiation of appropriate therapy. Methods This study retrospectively identified all patients referred to an outpatient clinic for pediatric pulmonology with functional respiratory disorders manifesting after proven SARS-CoV-2 infection between January 1, 2022, and October 31, 2022. Clinical history, thorough clinical examination regarding breathing patterns, and pulmonary function tests (PFTs) were taken into consideration to diagnose functional respiratory disorders. Results Twenty-five patients (44% female) with mean (m) age = 12.73 years (SD ± 1.86) who showed distinctive features of functional respiratory disorders after SARS-CoV-2 infection (onset at m = 4.15 (± 4.24) weeks after infection) were identified. Eleven patients showed thoracic dominant breathing with insufficient ventilation, and 4 patients mainly had symptoms of inducible laryngeal obstruction. The rest (n = 10) showed overlap of these two etiologies. Most patients had a flattened inspiratory curve on spirometry and slightly elevated residual volume on body plethysmography, but values of PFTs were normal before and after standardized treadmill exercise testing. Patients were educated about the benign nature of the condition and were offered rebreathing training. All patients with follow-up (n = 5) showed normalization of the breathing pattern within 3 months. Conclusions Functional respiratory disorders are important differential diagnoses in persisting post-SARS-CoV-2 dyspnea in adolescents. A combination of clinical history, detailed examination of breathing patterns, and pulmonary function tests are helpful to correctly diagnose these conditions. Reassurance and rebreathing training are the mainstay of the therapy. The clinical course is favorable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2

Bode,

Schwender,

Toth

et al. 2023

Mol Cell Pediatr

View full text Add to dashboard Cite

show abstract

“…The diagnosis of asthma is confirmed by detection of the airflow limitation, in practice by laboratory bronchial provocation tests (BPTs), but evaluation of diurnal variability in lung function may also be used in this manner, according to GINA - The Global Initiative for Asthma [ 11 ]. Except for individual case reports [ 15 ], we are unaware of previous studies that have been able to detect airflow limitation as a possible explanation of LC symptoms [ 6 , 7 ]. In this open diagnostic pilot study, the primary aim was to detect airflow limitation in LC patients, first by a methacholine BPT, and if negative, by evaluating diurnal variability in lung function by using a remote app-based spirometer over a two-weeks’ period [ 11 ].…”

Section: Introductionmentioning

confidence: 99%