##common.pageHeaderLogo.altText##

Original article

Vol. 155 No. 4 (2025)

Reporting of paediatric exercise-induced respiratory symptoms by physicians and parents: an observational prospective study

Cite this as:
Swiss Med Wkly. 2025;155:3939
Published
02.04.2025

Summary

STUDY AIMS: Routinely collected health data are increasingly used for research; however important anamnestic details may be missing from medical records. We compared physician documentation of paediatric exercise-induced respiratory symptoms in clinical notes with parental questionnaire responses for the same children.

METHODS: We analysed data from the Swiss Paediatric Airway Cohort (SPAC), a multicentre observational study of children treated in Swiss outpatient pulmonology clinics. We included children aged 6 to 17 years who were referred to a paediatric pulmonologist for evaluation of exercise-induced respiratory symptoms. Features of exercise-induced respiratory symptoms recorded by physicians were extracted from outpatient clinic letters transmitted to the referring physician, while parent-reported exercise-induced respiratory symptom data was collected from a standardised questionnaire completed at Swiss Paediatric Airway Cohort enrolment. We calculated agreement between physician-documented and parent-reported exercise-induced respiratory symptom characteristics using Cohen’s and Fleiss’s kappa.

RESULTS:Of 1669 children participating in the Swiss Paediatric Airway Cohort (2017–2019), 193 (12%) met the inclusion criteria, of whom 48% were girls. Physicians provided detailed information on exercise-induced respiratory symptoms in 186 (96%) outpatient clinic letters. Documented characteristics included: type of physical activity triggering exercise-induced respiratory symptoms (69%), location of exercise-induced respiratory symptoms in chest or throat (48%), respiratory phase of exercise-induced respiratory symptoms (45%) and timing of exercise-induced respiratory symptoms during or after exercise (37%). Previous bronchodilator use (94%) and its effect on exercise-induced respiratory symptoms (88%) were consistently documented by physicians. The clinic letters for children diagnosed with dysfunctional breathing more often contained detailed exercise-induced respiratory symptom characteristics than those diagnosed with asthma. The level of agreement between physician-documented and parent-reported exercise-induced respiratory symptoms was moderate for use of bronchodilators (κ = 0.53) and poor-to-fair for all other features (κ = 0.01–0.36).

CONCLUSION: This study highlights that outpatient clinic letters may lack some details on exercise-induced respiratory symptom characteristics – information that parents could provide. A standardised and detailed method for documenting paediatric respiratory symptoms in the coordinated data infrastructure may enhance future analyses of routinely collected health data.

References

  1. Johansson H, Norlander K, Malinovschi A. Increased prevalence of exercise-induced airway symptoms - A five-year follow-up from adolescence to young adulthood. Respir Med. 2019;154:76–81. doi: https://doi.org/10.1016/j.rmed.2019.06.011
  2. Kenn K, Hess MM. Vocal cord dysfunction: an important differential diagnosis of bronchial asthma. Dtsch Arztebl Int. 2008 Oct;105(41):699–704.
  3. Røksund OD, Heimdal JH, Clemm H, Vollsæter M, Halvorsen T. Exercise inducible laryngeal obstruction: diagnostics and management. Paediatr Respir Rev. 2017 Jan;21:86–94.
  4. Røksund OD, Heimdal JH, Olofsson J, Maat RC, Halvorsen T. Larynx during exercise: the unexplored bottleneck of the airways. Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2101–9. doi: https://doi.org/10.1007/s00405-014-3159-3
  5. Abu-Hasan M, Tannous B, Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what? Ann Allergy Asthma Immunol. 2005 Mar;94(3):366–71. doi: https://doi.org/10.1016/S1081-1206(10)60989-1
  6. Barker N, Everard ML. Getting to grips with ‘dysfunctional breathing’. Paediatr Respir Rev. 2015 Jan;16(1):53–61.
  7. Depiazzi J, Everard ML. Dysfunctional breathing and reaching one’s physiological limit as causes of exercise-induced dyspnoea. Breathe (Sheff). 2016 Jun;12(2):120–9. doi: https://doi.org/10.1183/20734735.007216
  8. Pedersen ES, Ardura-Garcia C, de Jong CC, Jochmann A, Moeller A, Mueller-Suter D, et al. Diagnosis in children with exercise-induced respiratory symptoms: A multi-center study. Pediatr Pulmonol. 2021 Jan;56(1):217–25. doi: https://doi.org/10.1002/ppul.25126
  9. Olin JT. Exercise-Induced Laryngeal Obstruction: When Pediatric Exertional Dyspnea Does not Respond to Bronchodilators. Front Pediatr. 2019 Mar;7:52. doi: https://doi.org/10.3389/fped.2019.00052
  10. Liyanagedera S, McLeod R, Elhassan HA. Exercise induced laryngeal obstruction: a review of diagnosis and management. Eur Arch Otorhinolaryngol. 2017 Apr;274(4):1781–9. doi: https://doi.org/10.1007/s00405-016-4338-1
  11. Pedersen ES, de Jong CC, Ardura-Garcia C, Mallet MC, Barben J, Casaulta C, et al. Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC). J Allergy Clin Immunol Pract. 2021 Feb;9(2):881–889.e3. doi: https://doi.org/10.1016/j.jaip.2020.09.012
  12. Niggemann B, Evers M, Härtl M. Psychogenic and functional disorders of the respiratory tract in children and adolescents—a pilot study. Pediatr Allergy Immunol. 2012 Sep;23(6):605–6. doi: https://doi.org/10.1111/j.1399-3038.2012.01295.x
  13. de Groot EP, Duiverman EJ, Brand PL. Dysfunctional breathing in children with asthma: a rare but relevant comorbidity. Eur Respir J. 2013 May;41(5):1068–73. doi: https://doi.org/10.1183/09031936.00130212
  14. Grüber C, Lehmann C, Weiss C, Niggemann B. Somatoform respiratory disorders in children and adolescents-proposals for a practical approach to definition and classification. Pediatr Pulmonol. 2012 Feb;47(2):199–205. doi: https://doi.org/10.1002/ppul.21533
  15. Martani A, Geneviève LD, Wangmo T, Maurer J, Crameri K, Erard F, et al. Sensing the (digital) pulse. Future steps for improving the secondary use of data for research in Switzerland. Digit Health. 2023 Apr;9:20552076231169826. 10.1177/20552076231169826
  16. Geneviève LD, Martani A, Mallet MC, Wangmo T, Elger BS. Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One. 2019 Dec;14(12):e0226015. doi: https://doi.org/10.1371/journal.pone.0226015
  17. Rakic M, Jaboyedoff M, Bachmann S, Berger C, Diezi M, do Canto P, et al. Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019. BMC Proc. 2021 Sep 20;15 (Suppl 13):19. 10.1186/s12919-021-00226-3
  18. Jaboyedoff M, Rakic M, Bachmann S, Berger C, Diezi M, Fuchs O, et al. SwissPedData: standardising hospital records for the benefit of paediatric research. Swiss Med Wkly. 2021 Dec;151(5152):w30069. 10.4414/SMW.2021.w30069
  19. Pedersen ES, de Jong CC, Ardura-Garcia C, Barben J, Casaulta C, Frey U, et al. The Swiss Paediatric Airway Cohort (SPAC). ERJ Open Res. 2018 Nov;4(4):00050–02018. 10.1183/23120541.00050-2018
  20. de Jong CC, Ardura-Garcia C, Pedersen ES, Mallet MC, Mueller-Suter D, Jochmann A, et al. Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process. J Allergy Clin Immunol Pract. 2023 Jan;11(1):187–194.e6. doi: https://doi.org/10.1016/j.jaip.2022.08.050
  21. Ardura-Garcia C, Mallet MC, Berger DO, Hoyler K, Jochmann A, Kuhn A, et al.; SPAC Study Team. Predictors of asthma control differ from predictors of asthma attacks in children: The Swiss Paediatric Airway Cohort. Clin Exp Allergy. 2023 Nov;53(11):1177–86. doi: https://doi.org/10.1111/cea.14390
  22. de Jong CC, Pedersen ES, Mozun R, Müller-Suter D, Jochmann A, Singer F, et al. Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort. Eur Respir J. 2020 Nov;56(5):2000132. doi: https://doi.org/10.1183/13993003.00132-2020
  23. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995 Mar;8(3):483–91. doi: https://doi.org/10.1183/09031936.95.08030483
  24. Kuehni CE, Brooke AM, Strippoli MP, Spycher BD, Davis A, Silverman M. Cohort profile: the Leicester respiratory cohorts. Int J Epidemiol. 2007 Oct;36(5):977–85. doi: https://doi.org/10.1093/ije/dym090
  25. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: https://doi.org/10.1016/j.jbi.2008.08.010
  26. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–74. doi: https://doi.org/10.2307/2529310
  27. Smoliga JM, Mohseni ZS, Berwager JD, Hegedus EJ. Common causes of dyspnoea in athletes: a practical approach for diagnosis and management. Breathe (Sheff). 2016 Jun;12(2):e22–37. doi: https://doi.org/10.1183/20734735.006416
  28. Tilles SA, Ayars AG, Picciano JF, Altman K. Exercise-induced vocal cord dysfunction and exercise-induced laryngomalacia in children and adolescents: the same clinical syndrome? Ann Allergy Asthma Immunol. 2013 Nov;111(5):342–346.e1. doi: https://doi.org/10.1016/j.anai.2013.07.025
  29. Vollsæter M, Stensrud T, Maat R, Halvorsen T, Røksund OD, Sandnes A, et al. Exercise Related Respiratory Problems in the Young-Is It Exercise-Induced Bronchoconstriction or Laryngeal Obstruction? Front Pediatr. 2022 Jan;9:800073. doi: https://doi.org/10.3389/fped.2021.800073
  30. Mohangoo AD, de Koning HJ, Hafkamp-de Groen E, van der Wouden JC, Jaddoe VW, Moll HA, et al. A comparison of parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview: The Generation R study. Pediatr Pulmonol. 2010 May;45(5):500–7. doi: https://doi.org/10.1002/ppul.21208
  31. Korsten K, Naaktgeboren CA, Bont LJ, van der Ent CK, de Hoog ML. Defining asthma in children: how well do parents, doctors and spirometry agree? ERJ Open Res. 2020 Oct;6(4):00348–02019. doi: https://doi.org/10.1183/23120541.00348-2019
  32. Shanmugam S, Nathan AM, Zaki R, Tan KE, Eg KP, Thavagnanam S, et al. Parents are poor at labelling wheeze in children: a cross-sectional study. BMC Pediatr. 2016 Jun;16(1):80. doi: https://doi.org/10.1186/s12887-016-0616-8