Differential Diagnosis
According to The American College of Chest Physicians (CHEST) guidelines
and Expert Panel Report, the differential diagnosis of cough occurring
in athletes over 12 years of age are EIB, asthma, respiratory tract
infections and upper airway cough syndrome due to rhinosinusitis.
Environmental factors that may significantly affect lung function should
also be taken into consideration26.
In a differential diagnosis of a young athlete presenting with breathing
difficulties, laryngeal wheeze during physical effort, dyspnea and
cough, exercise-induced vocal cord dysfunction (VCD) should also be
taken into consideration. Exercise-induced VCD affects up to 5-27% of
patients earlier diagnosed with EIB. In such cases during physical
effort, paradoxical motion of the vocal cords occurs, especially during
inspiration27. Particularly, patients with
difficult-to-treat asthma and athletes whose symptoms do not improve
after treatment should be considered in the differentiation from
exercise-induced VCD. Exercise-induced laryngomalacia may be another
presenting condition. In both cases FEV1 does not decrease after
exercise or after the administration of ß2-mimetics and / or inhaled
GKS.
Dysfunctional breathing (activation of additional inspiratory muscles,
with shallow breathing, and lifting of the chest wall), acquired and
habitual patterns of breathing, should also be considered in
differentiating EIB among young athletes. Dysfunctional breathing often
occurs in people with asthma. It is characterized by the absence of any
functional airway disorder, exercise-induced hyperventilation, and often
co-occurs with acute anxiety. As a result of hyperventilation,
respiratory alkalosis occurs, causing dyspnea, light-headedness, chest
tightness and paraesthesias.
When investigating dyspnea, it is widely emphasized to take
psychological factors into consideration, especially when working with
young patients. This is because dyspnea is a subjective measurement and
the symptoms that occur during exercise can be interpreted differently.
Rare pathologies causing exercise-induced symptoms, especially in
adolescent athletes, include hypertrophic cardiomyopathy (HCM), which is
the main cause of sudden cardiac death in this group. Other rare
pathologies that simulate EIB symptoms include: exercise-induced
arrhythmia, cardiovascular dysfunctions, pulmonary embolism, anemia,
interstitial lung disease, swimming induced pulmonary edema,
exercise-induced anaphylaxis, and myopathies.