Young and exhausted, by Filip Olekšák, Peter Ďurdík, Ľubica Jakušová, Tomáš Turčan, Peter Bánovčin in Advances in Respiratory Medicine 2021, vol. 89, no. 1, pages 1-4
Letter to the editors extracts:
Dysfunctional breathing (DB) is highly prevalent and is overlooked mainly in adolescents and often attributed to behavioural changes during adolescence . Chronic fatigue might be a symptom of DB in adolescents. We present a case study supporting this claim.
In the case report, we present a 13-year-old patient with chronic debilitating fatigue who
meets the criteria for CFS/ME. The patient and patient’s parents reported 6 months of fatigue, which was not improved even after an adequate period of sleep and very low physical performance. According to the parents, the patient has difficulty concentrating, is morose most of the day and reports limb twitching and paraesthesia.
The patient was examined in detail by a paediatrician (anamnestic unclear cause, resting tachycardia in the physical examination, laboratory tests within normal limits, serum minerals within normal limits), endocrinologist (normal hormonal profile for a given age, Tanner stage 3), infectologist (serology for typical viruses negative), psychologist (normal cognitive functions).
For a history of resting tachycardia, the patient was examined by a cardiologist, where no cardiogenic cause of fatigue was demonstrated, sinus tachycardia was present, and the patient was recommended head-up-tilt test, which showed the presence of postural orthostatic tachycardia. Due to the idiopathic nature of the difficulties and the excluded secondary cause, a two-day protocol examination by cardiopulmonary exercise testing was indicated.
CPET confirmed the presence of DB in the patient based on the low resting value of ETCO2, the existence of a chaotic pattern of respiration during resting and exercise with the presence of tachypnoea (with very low ventilatory efficiency) in maximal exertion. Diagnosis of DB using CPET is one of the methods of DB diagnostics. Proper respiratory rehabilitation and psychological guidance resulted in the patient fixing the respiratory pattern and subsequently eliminating the primary cause of the examination — chronic fatigue.
Patients with CFS/ME are a common paediatric problem. The current possibilities of diagnostics are enriched by the possibility of performing CPET, which can be a benefit in differential diagnostics as well as in confirming the diagnosis. Patients with CFS/ME and/or postural orthostatic tachycardia should be checked for the presence of DB as a treatable cause of clinical symptoms.