BREAThe (Respiratory Medicine) Referral Criteria

The Breathlessness during Exercise Assessment and Treatment (BREAThe) Clinic within the Division of Respiratory Medicine provides specialized assessment and management for children and adolescents with complex exercise-related breathing symptoms that are difficult to diagnose, refractory to usual therapy or require advanced diagnostic assessment.

All internal and external health-care providers.

Under 17.5 years at the time of referral.

Exercise-related shortness of breath is common in children and adolescents. The BREAThe Clinic provides assessment and follow-up primarily for patients with complex, refractory, or diagnostically unclear presentations.

Patients with uncomplicated or well-controlled exercise-induced asthma, suspected physical deconditioning or otherwise mild intermittent symptoms should be referred to a community provider (see list of community Respirologists under Asthma clinic page). If the patient has a significant comorbid disorder (e.g. existing respiratory or cardiac disease) that limits their physical activity or exercise tolerance, please refer this patient to the General Chest Clinic or Cardiology clinic for initial assessment.

Referral Criteria (one or more required):

• Exercise-Induced Laryngeal Obstruction (EILO)
  • Also known as Vocal Cord Dysfunction (VCD)/Paradoxical Vold Fold Motion (PVFM)
  • Suspected diagnosis requiring diagnostic confirmation and/or treatment
• Exercise-induced asthma – refractory to treatment*

• Dysfunctional breathing, including breathing pattern disorders (BPD)
• Resulting in significant limitation during exercise and/or affecting performance in activity/sport
• Shortness of breath on exertion - not yet diagnosed (NYD)
• These referrals will be reviewed on a case-by-case basis
• Requires prior assessment by specialist and work-up without a definitive diagnosis
• Resulting in significant limitation during exercise and/or affecting performance in activity/sport
• Second opinions requested by a paediatric respirologist or other relevant specialist

*Appropriate inhaler technique and adherence with at least 6-weeks of treatment with pre-exercise bronchodilator (e.g. 2-4 puffs of salbutamol/Ventolin or alternative bronchodilator) AND/OR adequate trial of moderate dose daily inhaled corticosteroids or ICS/LABA with ongoing symptoms or limitation during exercise

The following investigations must be completed for referrals to be accepted (unless otherwise discussed with the clinic):

Mandatory (within last 12 months):

• Electrocardiogram (ECG)
• Echocardiogram
• Baseline pulmonary function testing, including:
• Spirometry
• Bronchodilator responsiveness testing
• Chest X-ray
• Blood work: Complete blood count (CBC) with differential, Ferritin level – within the last 6 months

PLEASE NOTE: Incomplete referrals may be returned or deferred until required investigations are available.

The following patients are generally not accepted for ongoing follow-up in the BREAThe Clinic:

• Well-controlled exercise-induced asthma responsive to standard therapy
• Patients who have not yet completed a trial of pre-exercise bronchodilators and/or daily inhaled corticosteroids for presumed exercise-induced asthma
• Concern for deconditioning as primary etiology of exercise symptoms
• Patients whose primary issue is non-exercise-related respiratory disease
• Patients with underlying chronic respiratory or cardiac condition that is likely to limit exercise capacity – please refer to General Chest clinic or Cardiology clinic first

Please consider referral to a community paediatric respirologist/asthma clinic for patients with mild or uncomplicated exercise-related symptoms, as this may allow for shorter wait times and easier access to care.

Days Operational

• 1-2 Wednesdays/month