The SARS-CoV-2 pandemic has caused significant pulmonary morbidity and mortality in the adult population. Children and adolescents typically show milder symptoms; however, a relevant proportion of them report persistent pulmonary symptoms even after mild SARS-CoV-2 infection. Functional respiratory disorders may be relevant differential diagnoses of persistent dyspnea. This study aims at characterizing functional respiratory disorders that may arise after SARS-CoV-2 infection regarding their clinical presentation and pulmonary function tests as well as gaining insights into the clinical course after initiation of appropriate therapy. This study retrospectively identified all patients referred to an outpatient clinic for pediatric pulmonology with functional respiratory disorders manifesting after proven SARS-CoV-2 infection between January 1, 2022, and October 31, 2022. Clinical history, thorough clinical examination regarding breathing patterns, and pulmonary function tests (PFTs) were taken into consideration to diagnose functional respiratory disorders. Twenty-five patients (44% female) with mean (m) age = 12.73 years (SD ± 1.86) who showed distinctive features of functional respiratory disorders after SARS-CoV-2 infection (onset at m = 4.15 (± 4.24) weeks after infection) were identified. Eleven patients showed thoracic dominant breathing with insufficient ventilation, and 4 patients mainly had symptoms of inducible laryngeal obstruction. The rest (n = 10) showed overlap of these two etiologies. Most patients had a flattened inspiratory curve on spirometry and slightly elevated residual volume on body plethysmography, but values of PFTs were normal before and after standardized treadmill exercise testing. Patients were educated about the benign nature of the condition and were offered rebreathing training. All patients with follow-up (n = 5) showed normalization of the breathing pattern within 3 months. Functional respiratory disorders are important differential diagnoses in persisting post-SARS-CoV-2 dyspnea in adolescents. A combination of clinical history, detailed examination of breathing patterns, and pulmonary function tests are helpful to correctly diagnose these conditions. Reassurance and rebreathing training are the mainstay of the therapy. The clinical course is favorable.

中文翻译：

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患有功能性呼吸系统疾病和既往 SARS-CoV-2 病史的青少年的特征

SARS-CoV-2 大流行已导致成年人群中严重的肺部发病率和死亡率。儿童和青少年通常表现出较轻微的症状；然而，其中相当一部分人报告称，即使在轻度 SARS-CoV-2 感染后，肺部症状仍持续存在。功能性呼吸障碍可能是持续性呼吸困难的相关鉴别诊断。本研究旨在描述 SARS-CoV-2 感染后可能出现的功能性呼吸系统疾病的临床表现和肺功能测试，并深入了解开始适当治疗后的临床过程。本研究回顾性地确定了 2022 年 1 月 1 日至 2022 年 10 月 31 日期间转诊至儿科肺科门诊的所有患有功能性呼吸系统疾病的患者，这些患者是在 2022 年 1 月 1 日至 2022 年 10 月 31 日期间被证实感染 SARS-CoV-2 后出现的。考虑肺功能测试（PFT）来诊断功能性呼吸系统疾病。25 名平均 (m) 年龄 = 12.73 岁 (SD ± 1.86) 的患者（44% 女性）在 SARS-CoV-2 感染后表现出功能性呼吸系统疾病的独特特征（发病时间为 m = 4.15 (± 4.24) 周后）感染）被识别。11例患者表现为胸段主导呼吸伴通气不足，4例患者主要表现为诱导性喉阻塞症状。其余的（n = 10）显示这两种病因有重叠。大多数患者在肺活量测定中吸气曲线平坦，在身体体积描记法中残余气量略有升高，但在标准化跑步机运动测试前后 PFT 值正常。患者接受了关于这种疾病的良性性质的教育，并接受了再呼吸训练。所有随访患者 (n = 5) 在 3 个月内均显示呼吸模式正常化。功能性呼吸系统疾病是青少年持续出现 SARS-CoV-2 后呼吸困难的重要鉴别诊断。结合临床病史、详细的呼吸模式检查和肺功能测试有助于正确诊断这些病症。安抚和再呼吸训练是治疗的支柱。临床过程良好。