Continuing to be a Champion: Groundbreaking technique offers breathing relief to young athletes

By Arianna Flores

At 13, Jessye Tout is already a champion. A multi-sport athlete, she has tackled soccer, dance, volleyball and karate since she was a little girl. But sometimes when she was on the soccer field, Jessye’s chest would start to hurt, and she couldn’t breathe. Mysteriously, this never happened while she was at school or doing day-to-day tasks, but only while she was exerting herself on the field. 

A visit with a pulmonologist ruled out a heart problem but did not shed more light on her problem. So, she was referred to John Robertson, M.D., a Cook Children’s Pediatric Pulmonologist, at the Exercise Respiratory Center (ExRC) in Prosper. 

To help find out what was wrong, Dr. Robertson and his team in August performed what is believed to be the world's first continuous bronchoscopy during exercise (CBE) on a pediatric patient. This technique had been done on adult patients but never on pediatric patients.

The team put a camera through Jessye’s nose and past her voice box, conducting a more in-depth look at her breathing capabilities— all while she ran on a treadmill to mimic the same symptoms she had while playing soccer.

Dr. Robertson said by replicating the exercise Jessye is doing on the field, the team could see in real time whether it was Jessye’s voice box or her windpipe that were behind her breathing discomfort. For young athletes with breathing problems, doctors often do a bronchoscopy while the patient is under sedation or general anesthesia. But this does not help the team to accurately observe the issue she experienced during exercise.

“The groundbreaking part of our CBE is that it was done in a pediatric patient. So far, all of the published medical literature on the subject has been done in adults,” Dr. Robertson said.

Jessye’s mother, Tracy Tout said it was important to keep pushing for answers because she did not want to see her daughter give up the sports she loves or stop exercising all together because of breathing problems. 

“I thought that there had to be a reason why she can't breathe. She's not making it up,” Tout said.

“It was 200 % important [to keep pushing for answers] because she has played select soccer pretty much her whole life,” Tout said. It's hard as a parent to sit there on the sidelines and have these coaches yell at her, saying ‘you just need to be conditioned’. And I thought, ‘You don't understand. She is conditioned, she's in athletics. There is not a kid that's more conditioned than she is.”

Rebecca Brovina, BSN, RN, CPN, Research Nurse Coordinator, and Andreas Kreutzer, Ph.D., Exercise Physiologist and Research Scientist, said they spent three months preparing for the new CBE procedure. Andreas even served as a test patient, twice undergoing the new procedure while running on the treadmill. To get Jessye ready, they shared Andreas’ experience, and also helped her prep for her own treadmill run.

For many young athletes, when treating asthma does not help their symptoms, we often find exercise-induced laryngeal obstruction (EILO), in which the voice box structure closes or collapses during exercise, making it hard to breathe. For these cases, speech therapy can often solve the issue. But if physicians find that the walls of the patient’s windpipe are weak, a condition called tracheomalacia, the treatment could involve open chest surgery.

For Jessye, the combination of CLE and CBE procedure yielded answers. Dr. Robertson concluded she needed speech therapy to help stop her voice box from closing while she was exercising. 

“I was really happy once I finally got answers,” she said, after having symptoms for more than eight months. “It is a long time to not know why you're feeling like you can't breathe.”