Continuous bronchoscopy during exercise in a pediatric patient: A case report

Exercise-induced respiratory symptoms limit physical activity and sport performance in adolescents. Etiologies include exercise-induced bronchoconstriction, laryngeal obstruction, dysfunctional breathing, and in rarer cases, large airway obstruction and cardiac pathologies. Accurate diagnosis requires assessment during exercise that elicits the symptoms patients experience in the field. This is particularly important considering that misdiagnosis with asthma is common among those with laryngeal obstruction and leads to ineffective treatment and increased financial burden for patients and families. Continuous laryngoscopy is the gold standard for the evaluation of intermittent upper airway obstruction during exercise. Researchers recently established the feasibility of continuous bronchoscopy during exercise to assess the large airway in adults. We present the case of a 13-year-old female patient reporting dyspnea, chest tightness, and wheezing during exercise. A double aortic arch causing mild fixed tracheal compression did not appear to explain her symptoms. Vascular rings can cause tracheomalacia, another possible source of intermittent obstruction during exercise. We performed continuous bronchoscopy during exercise following continuous laryngoscopy during a cardiopulmonary exercise test. We found exercise-induced laryngeal obstruction and ruled out tracheomalacia and other potential causes. To our knowledge, this was the first continuous bronchoscopy during exercise performed in a pediatric patient worldwide.