Background: Athletic activities are increasingly popular among adolescents. Many complain of dyspnea during their activity.

Objective: There has been controversy regarding the assessment of dyspnea on exertion. The various methods will be discussed and critiqued.

Methods: Careful literature review with details of the methodologies used to evaluate dyspnea on exertion in adolescent athletes.

Results: Determination of etiology that is not from asthma can be achieved with cardiopulmonary testing during exercise with physiology determined during reproduced symptomatic dyspnea. Utilizing continuous laryngeal monitoring reported a prevalence of vocal cord dysfunction (VCD) or inducible laryngeal (ILO) in 5-8% of adolescents and 20% of regular exercise participants.[i] Those implausible prevalences are likely a result of the methodology that identifies VCD or ILO based on observations that include movements of aryepiglottic folds and vocal cord adduction without airway obstruction.[ii]

Conclusions: There is now sufficient evidence that continuous laryngeal monitoring during exercise cannot identify the cause of exercise-induced dyspnea. Determination of exercise-induced dyspnea etiology that is not from asthma can best be achieved with cardiopulmonary testing during exercise. Measurements then include oxygen utilization, carbon dioxide production, heart rate and ECG monitoring, respiratory rate, maximum tidal volume, flow-volume loop monitoring, minute ventilation, oximetry, pH, and pCO₂  (an alternative to arterial catheter is a finger stick as exercise is terminated).[iii] If decreased flows during flow-volume monitoring with or without stridor are seen in association with reproduced dyspnea, prompt laryngoscopy while symptomatic can identify the specific laryngeal cause of upper airway obst

[i] Leong P, Vertigan AE, Hew M, Baxter M, Phyland D, Hull JH, et al. Diagnosis of vocal cord dysfunction/inducible laryngeal obstruction: an International Delphi Consensus Study. J Allergy Clin Immunol 2023. Online ahead of print.

[ii] Olin TJ. Exercise-induced laryngeal obstruction: When pediatric exertional dyspnea does not respond to bronchodilator. Front Pediatr 2019 1;7:52.

[iii] Bhatia R, Abu-Hasan M, Weinberger M. Exercise-induced dyspnea in children and adolescents: Differential diagnosis. Pediatr Ann 2019;48:e121-127.