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Not all wheeze is asthma: time for patients to exercise their rights
  1. J H Hull
  1. Correspondence to Dr James H Hull, Department of Respiratory Medicine, Royal Brompton Hospital, Fulham Road, London SW3 6HP, UK; j.hull{at}

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It is now over a century since Sir William Osler first highlighted the fact that not all breathlessness and wheeze is caused by asthma; with a description that in some, … ‘the laryngeal muscle can spasm during periods of stress’ and as such act to mimic bronchoconstriction.1

Yet despite 100 years of medical progress, when a young individual presents with exertional breathlessness, all too often he or she will get promptly labelled as asthmatic.2 ,3 Indeed, we know from studies conducted in both the UK3 and USA,4 that when faced with this clinical presentation, primary care physicians have poor access to the most accurate diagnostic tools and a trial of inhaled asthma therapy is often, therefore, employed with ‘diagnostic’ intent. This is despite the countless number of studies indicating that clinical assessment in this capacity is at best imprecise and at worst no better than a coin toss.5–7 In other words, in young individuals objective testing is required to determine the cause of their exertional breathlessness.

But work, gathering pace over recent years, is now acting to shine a light on the importance of diagnostic precision in this area.2 ,8 It is on this basis we should welcome the study by Johansson et al9 with the aim of evaluating the prevalence of the differential diagnoses for exertional breathlessness in adolescents.

A key condition addressed in this study is exercise-induced laryngeal obstruction (EILO); …

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