Respiratory medicine and research · 2025
Impact of a pediatric dyspnea clinic management on patients with unexplained exertional dyspnea: cross-sectional assessment at three months.
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Coquelin Florence, Bourmaud Aurélie, Fuchs-Climent Deborah, Toumazi Artémis, Coste Pierre, Buridans-Travier Nellie, Benzouid Chérine, Houdouin Véronique, Delclaux Christophe, Peiffer Claudine, Pautrat Jade
Аннотация
BACKGROUND: While unexplained exertional dyspnea (ED) is a frequent complaint in children, there is little consensus on its management. Our pediatric dyspnea clinic provides multidisciplinary assessment and management of ED that includes a psychological interview and a breathing retraining. The aim of this study was to determine the evolution of ED 3±1 months after the visit at the dyspnea clinic (day 0) and to identify factors associated with improvement of ED.
METHODS: This cross-sectional monocentric cohort study included children referred to our dyspnea clinic between March 2018 and January 2021 for unexplained ED. Thereafter, we reassessed patients by a telephone interview. The evolution of ED between day 0 and 3±1 months after dyspnea clinic was assessed with a score ranging from -8 (most important worsening of dyspnea) to +8 (most important improvement of dyspnea). Factors associated with an improvement in ED were identified through a multivariate analysis.
RESULTS: We included 74 patients (median age 13.1 years, 44 girls) and reassessed 68 of them. The median of ED evolution score (ESc) between day 0 and 3±1 months after dyspnea clinic was 4.0 [0.0; 8.0]. Improvement in ED (ESc >0) was observed in 46 children (68%) among whom 70% (32) had a near maximal ESc (≥6/8) Lower compliance (< 4 days per week) with breathing exercises performed at home was associated with fewer improvement in ED (OR = 0.20 [0.04; 0.87], p = 0.03).
CONCLUSION: Three months after the visit to our dyspnea clinic, most patients had improved their ED with a near maximal improvement in almost half of all patients. Compliance with breathing exercises is essential for a better outcome.
METHODS: This cross-sectional monocentric cohort study included children referred to our dyspnea clinic between March 2018 and January 2021 for unexplained ED. Thereafter, we reassessed patients by a telephone interview. The evolution of ED between day 0 and 3±1 months after dyspnea clinic was assessed with a score ranging from -8 (most important worsening of dyspnea) to +8 (most important improvement of dyspnea). Factors associated with an improvement in ED were identified through a multivariate analysis.
RESULTS: We included 74 patients (median age 13.1 years, 44 girls) and reassessed 68 of them. The median of ED evolution score (ESc) between day 0 and 3±1 months after dyspnea clinic was 4.0 [0.0; 8.0]. Improvement in ED (ESc >0) was observed in 46 children (68%) among whom 70% (32) had a near maximal ESc (≥6/8) Lower compliance (< 4 days per week) with breathing exercises performed at home was associated with fewer improvement in ED (OR = 0.20 [0.04; 0.87], p = 0.03).
CONCLUSION: Three months after the visit to our dyspnea clinic, most patients had improved their ED with a near maximal improvement in almost half of all patients. Compliance with breathing exercises is essential for a better outcome.