Vocal Cord Dysfunction in Patients With Exertional Dyspnea

Morris, Michael J.; Deal, Leonard E.; Bean, Donald R.; Grbach, Vincent X.; Morgan, James A.

doi:10.1378/chest.116.6.1676

Cited by 172 publications

(142 citation statements)

References 14 publications

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“…An indication of the prevalence of this condition can be found in a study of military subjects with exertional dyspnoea where direct visualisation of the vocal cords by flexible laryngoscopy was performed before and after exercise to determine the incidence of VCD: 15% were found to have adduction of the cords. 6 Newman et al found that 56% of 95 laryngoscopically confirmed patients with VCD also had asthma. 7 VCD typically occurs in young females and may be precipitated by exercise, odours, and infections.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas flattening of the inspiratory section of the flow volume loop is often cited as a typical finding in this condition, only 20% of subjects in the military study previously mentioned demonstrated this finding. 6 Laryngoscopy may reveal adduction of the vocal cords but it is difficult to perform this procedure at the high levels of ventilation which may be required for precipitation of the condition.…”

Section: Discussionmentioning

confidence: 99%

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Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Fallon

2004

Br J Sports Med

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This case concerns an elite road cyclist who complained of occasional dyspnoea and inspiratory difficulty during intense exercise. Clinical examination was normal and the final diagnosis was vocal cord dysfunction, a paradoxical closure of the vocal cords during inspiration which is highly associated with inspiratory stridor at high rates of ventilation. Awareness by the sports physician of this not uncommon condition is important to avoid misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Fallon

2004

Br J Sports Med

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“…Allergic bronchopulmonary aspergillosis and pulmonary eosinophilic syndromes may be considered unique diseases with some of the clinical features of asthma and are often difficult to treat; these are probably best considered outside the definition of difficult/therapy-resistant asthma. Vocal cord dysfunction (VCD), characterised by adduction of the vocal cords, can masquerade as asthma or may coexist with asthma, which could result in asthma appearing more severe than it really is [10,11]. In one study [11], 16.7% of patients with refractory asthma and referred for tertiary care had coexisting VCD and asthma.…”

Section: Diagnosis Considerationsmentioning

confidence: 99%

Examining the unmet need in adults with severe asthma

Partridge¹

2007

European Respiratory Review

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Asthma currently affects an estimated 300 million people worldwide and the number is expected to rise to 400 million by 2025. Asthma morbidity remains high and the economic burden is significant. Approximately 20% of patients have severe persistent asthma. As patients with severe asthma often have a variety of conditions that may coexist with or be mistaken for asthma, careful diagnosis and management are essential, and adhering to a protocol for investigations is helpful.For patients with severe persistent asthma, the Global Initiative for Asthma 2005 guidelines recommend the use of high-dose inhaled corticosteroids in combination with a long-acting b 2 -agonist, with one or more additional controller medications if required (step 4 therapy). However, recent studies have shown that asthma remains inadequately controlled in many patients with severe asthma, despite treatment in accordance with guidelines.Patients with severe asthma have the highest healthcare utilisation and mortality, and there is clearly an unmet need for the effective and safe treatment of patients with severe persistent allergic asthma who remain symptomatic despite optimised standard treatment. The latest guidelines suggest that omalizumab may address this unmet need.

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“…In a cohort in the study by NEWMAN et al [5], methacholine challenge testing (MCT) induced VCD in nine out of 12 subjects with normal laryngoscopy. MORRIS et al [3] demonstrated changes in inspiratory limbs of flow-volume loops in four out of 10 VCD patients with MCT, but did not correlate these findings with laryngoscopy. There has only been one prospective evaluation of MCT in the diagnosis of VCD.…”

Section: Bronchial Provocation Testsmentioning

confidence: 93%

“…However, in a group of 1,025 patients evaluated for exertional dyspnoea, 29 (2.4%) were found to have VCD [2]. In a smaller study of 105 army recruits evaluated for dyspnoea, 10 (9.5%) were found to have VCD [3].…”

Section: Epidemiologymentioning

confidence: 99%