Paradoxic Vocal Cord Motion in Presumed Asthmatics

Martin, Richard J.; Blager, Florence B.; Wood, Raymond P.

doi:10.1055/s-2007-1012672

Cited by 123 publications

(76 citation statements)

References 3 publications

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“…Although it is well recognized that some patients with VCD also have asthma and sinus disease, many have vocal cord abnormalities without asthma. 1,3,5,29 In the present study, these VCD subjects were subsequently shown to have low total IgE, absolute eosinophil counts ≤100/μL, and, in the four subjects who subsequently had CT scans, scores of 0, 1, 4, and 5 (ie, they had no evidence for an inflammatory process). Thus, the investigations used here could provide a basis for identifying VCD and distinguishing VCD from asthma.…”

Section: Discussionmentioning

confidence: 47%

Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma

Peters¹,

Hatley²,

Crater³

et al. 2003

Annals of Allergy, Asthma & Immunology

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Section: Discussionmentioning

confidence: 47%

Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma

Peters¹,

Hatley²,

Crater³

et al. 2003

Annals of Allergy, Asthma & Immunology

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“…It was suspected that many of these patients may have been suffering from vocal cord dysfunction, which also is recognized as being amenable to therapy with hypnosis. 13 However, most of these patients were taught self-hypnosis without a definitive diagnosis of vocal cord dysfunction, which is typically made definitively by visualization of adducted cords using nasopharyngeal fiber-optic laryngoscopy during an acute episode. 14 Because use of hypnosis was associated with rapid resolution of symptoms of most of these patients, there was no need to undertake additional investigations, such as exercise pulmonary function testing for provocation of symptoms and/or laryngoscopic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Self-Hypnosis for Management of Chronic Dyspnea in Pediatric Patients

Anbar

2001

Pediatrics

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ABSTRACT. Introduction. Hypnotherapy can be useful in the management of anxiety, discomfort, and psychosomatic symptoms, all of which may contribute to a complaint of dyspnea. Therefore, instruction in self-hypnosis was offered to 17 children and adolescents with chronic dyspnea, which had not resolved despite medical therapy, and who were documented to have normal lung function at rest. This report documents the result of this intervention.Methods. A retrospective chart review identified all patients followed by a single pediatric pulmonologist (R.D.A.), with a chief complaint of chronic dyspnea from April 1998 through December 1999. These patients had been evaluated and treated for medical diseases according to their history, physical examination, and laboratory investigations. The pulmonologist offered to teach selfhypnosis to all of these patients, who comprise the cohort in this report.Chronic dyspnea was defined as recurrent difficulty breathing or shortness of breath at rest or with exertion, which had existed for at least 1 month in patients who had not suffered within a month from an acute pulmonary illness.The pulmonologist was trained in hypnosis through his attendance at three 20-hour workshops.Hypnosis was taught to individual patients in 1 or two 15-to 45-minute sessions. Patients were taught hypnotic self-induction techniques and imagery to achieve relaxation. Additionally, imagery relating to dyspnea was developed by coaching patients to change their imagined lung appearance from a dyspneic to a healthy state. Patients were encouraged to practice self-hypnosis regularly and to use lung imagery to eliminate dyspnea if it occurred.Results. Seventeen patients (13 males and 4 females) with chronic dyspnea were documented to have normal pulmonary function at rest. Their mean age was 13.4 years (range: 8 -18 years). Twelve of the 17 previously were diagnosed with other conditions, such as allergies, asthma, and gastroesophageal reflux. Fifteen of the 17 manifested at least 1 other symptom associated with their dyspnea, including an anxious appearance (4 patients); chest tightness or pain (5); cough (4); wheeze (3); difficulty with inspiration (2); hyperventilation (1); inspiratory noise, such as stridor, gasping, rasping, or squeak (8); dizziness (1); feeling something is stuck in the throat (2); parasthesias (4); and tachycardia (3).Of the 17 patients, 2 complained of dyspnea at rest only, 13 complained of dyspnea with activity only, and 2 complained of dyspnea both at rest and with activity. Nine patients reported that they frequently needed to discontinue their physical activity because of dyspnea. The mean duration of their dyspnea before learning selfhypnosis was 2 years (range: 1 month to 5 years). The dyspnea was of <6 months duration for 4 of the patients.For 9 of the 17 patients a potential psychosocial association with their dyspnea was identified: 3 developed symptoms at school only; 2 with exercise during competitive races only; 3 after a major disagreement between their parents; and 1 deve...

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“…This could be due to prior sedation before this procedure, or performing it after the attack had settled. In the latter situation certain manoeuvres may help to provoke the abnormal movement [3].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was educated about the nature of her breathing difficulty, taught breathing exercises (as described by MARTIN et al [3]), and had an improvement in her pulmonary symptoms. She declined to undergo bronchial challenge testing with methacholine.…”

Section: Psychological Vocal Cord Dysfunctionmentioning

confidence: 99%

See 1 more Smart Citation

Psychogenic vocal cord dysfunction simulating bronchial asthma

Mobeireek¹,

Alhamad²,

Al-Subaei³

et al. 1995

Eur Respir J

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P Ps sy yc ch ho og ge en ni ic c v vo oc ca al l c co or rd d d dy ys sf fu un nc ct ti io on n ssi im mu ul la at ti in ng g b br ro on nc ch hi ia al l a as st th hm ma a We report three Saudi females with this condition, in whom polygamy and a large family system created associated social stress. Spirometry with a flow-volume loop showed characteristic features, and in all three this test was the most important clinical tool that led to the correct diagnosis.Clinicians should perform spirometry and flow-volume loop tests routinely in patients presenting with asthmatic symptoms, and look for clues suggestive of this condition, including a psychosocial assessment. Eur Respir J., 1995Respir J., , 8, 1978Respir J., -1981 Vocal cord dysfunction secondary to psychogenic factors (PVCD) was first recognized in 1974, presenting as organic upper airways obstruction [1]. Presentations with a picture simulating bronchial asthma were later described. A recent review summarized 48 cases found in the English language literature [2]. Interest in this condition is focused both on features that may help in its recognition and, therefore, avoid the serious consequences resulting from misdiagnosis, and on the underlying psychodynamics. We report, for the first time to our knowledge, three patients from the Middle East region, and discuss the relevance of cultural stresses and diagnostic clues, particularly the flowvolume loop. Case reportsCase No. 1 A 40 year old woman was admitted to hospital with moderate and severe attacks of bronchial asthma on eight occasions between 1988 and 1992. She was first labelled asthmatic after admission to another hospital in Riyadh in 1986. These attacks were characterized by dyspnoea, cough and wheeze, with no clear precipitating factors, except on two of her admissions where a history of a flu-like illness was given. There was no history of other atopic disorders and no family history of asthma.On examination, the patient was tachypnoeic and tachycardic, and diffuse inspiratory and expiratory rhonchi were heard. Multiple investigations were performed including full and differential blood counts, chest roentgenography, computed tomography of the chest and electrcardiography which revealed no abnormality. Initial arterial oxygen tension (Pa,O 2 ) ranged 7.9-8.4 kPa and arterial carbon dioxide tension (Pa,CO 2 ) was in the normal range, except during her two intensive care admissions when she developed CO 2 retention with acidosis. She was refractory to high dose parenteral corticosteroids.Peak expiratory flow rate values were erratic. Spirometric values in 1991 were: forced expiratory volume in one second (FEV1): 1.5 L (62% of predicted); forced vital capacity (FVC) 1.6 L (55% pred); and maximum expiratory flow at 50% of vital capacity (MEF50) 2.4 L·s -1 (55% pred). In 1992, values were: FEV1 2.3 L (92% pred); FVC: 2.6 L (86% pred), and MEF50 4.2 L·s -1 (94% pred). There was no significant change in these values after giving a bronchodilator. Inspiratory flows were reduced on both occasions, ...

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Paradoxic Vocal Cord Motion in Presumed Asthmatics

Cited by 123 publications

References 3 publications

Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma

Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma

Self-Hypnosis for Management of Chronic Dyspnea in Pediatric Patients

Psychogenic vocal cord dysfunction simulating bronchial asthma

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