Atypical asthma in children who present with isolated chest tightness: risk factors and clinical features

Abstract

ObjectiveAsthmatic children presenting with chest tightness as the only symptom have not been widely recognized. This study attempted to find risk factors, summarize clinical features and offer some suggestions for the diagnosis of this atypical asthma.Methods: We studied 94 children, aged 6 to 14 years, who complained only of chest tightness. Data from clinical manifestations and laboratory tests were analyzed. The atypical asthma group (n = 58) showed positive bronchial challenge tests, and symptoms either improved or resolved in response to the bronchodilator. The control group (n = 36) had negative results on the bronchial challenge, diurnal PEF, and BDR tests, and no response to asthma treatment with bronchodilator.Results: Pollution, weather, recent house renovation, and air-conditioning use may be risk factors for children with atypical asthma. These children had more accompanying symptoms of rhinitis and rhinitis family history (P < 0.05), and a higher positive detection rate of inhaled allergens and multiple sensitizations. Parameters of the pulmonary function test were lower in the atypical asthma group than in the control group, and they also had higher FeNO values. If a cutoff value of improvement in FEV1 of BDR were set at 8.9%, sensitivity would be 48.2%, which is higher than a 12% cutoff.Conclusions: Environmental factors appeared to cause development of the isolated chest tightness symptom. Clinical history and laboratory tests could provide partial values for this diagnosis. In the absence of a bronchial challenge test, a margin of improvement in FEV1 of BDR set at 8.9% may be helpful.

Keywords:

• Chest tightness
• atypical asthma
• children
• risk factors
• diagnosis

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Authors’ contributions

Wenjing Zhu drafted the article and conducted the primary statistical analysis. Li Sha and Chuanhe Liu initiated the study design and conceived of the study. Li Sha and Kai Guan revised the article. Shuo Li performed the bronchial reversibility test and bronchial challenge test. Mingjun Shao and Kai Guan assisted with data collection and carried out the implementation. Jing Zhao provided statistical expertise in clinical trial design. Yuzhi Chen supervised the project. All authors contributed to refinement of the study protocol and approved the final manuscript.

Additional information

Funding

This work was supported by the Special Project for Research Foundation of the Capital Institute of Pediatrics [number FX-2018–07] and Yang Fan Plan of the Beijing Medical Administration [number ZYLX201829].