2022 Volume 36 Issue 5 Pages 485-489
This case involved an 11-year-old boy. The patient started playing rugby at the age of nine, and wheezing and breathing difficulty developed during exercise. The patient was diagnosed with bronchial asthma, and inhalation of fluticasone 100 μg/day and oral leukotriene receptor antagonist were initiated for prevention. Wheezing during exercise did not improve, and the patient was gradually administered inhaled corticosteroid to fluticasone furoate/vilanterol 200 μg/day. The addition of theophylline 200 mg/day did not improve the patient's condition. The patient was referred to our hospital and underwent an exercise challenge test. From spirometry, we suspected exercise-induced laryngeal obstruction (EILO), and a definitive EILO diagnosis was made based on laryngeal fiberscope findings during subsequent exercise. After recommending inspiratory muscle training and ultimately suspecting gastroesophageal reflux as an exacerbating factor for EILO, oral administration of a proton pump inhibitor improved the symptoms. Therefore, the following are of paramount importance: (1) considering EILO in cases with poor response to treatment as exercise induced asthma; (2) performing exercise load and spirometry at an easily manageable and conducive level for children; and (3) endeavoring toward appropriate diagnosis and treatment.
