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Vocal cord dysfunction in patients with exertional dyspnea
M J Morris1, L E Deal, D R Bean
1Pulmonary Disease/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200, USA. Michael.Morris@cen.amedd.army.mil
Chest
|December 14, 1999
Summary
Vocal cord dysfunction (VCD) is common in military personnel with exertional dyspnea. Flexible laryngoscopy is key to diagnosing this condition, which causes paradoxical inspiratory vocal cord closure.
Area of Science:
- Pulmonology
- Otolaryngology
- Exercise Physiology
Background:
- Exertional dyspnea is a common complaint in military populations.
- Vocal cord dysfunction (VCD) can mimic other respiratory conditions.
- Accurate diagnosis of VCD is crucial for appropriate management.
Purpose of the Study:
- To evaluate the prevalence of VCD in military patients presenting with exertional dyspnea.
- To assess the utility of flexible laryngoscopy in diagnosing VCD in this population.
Main Methods:
- A cross-sectional, controlled study was conducted at an army tertiary care center.
- Forty military patients with exertional dyspnea and 12 asymptomatic controls underwent evaluation.
- Flexible laryngoscopy was performed before and after exercise to detect inspiratory vocal cord adduction.
Main Results:
- Fifteen percent of patients with exertional dyspnea were diagnosed with VCD.
- VCD-positive patients showed minimal differences in resting pulmonary function tests compared to VCD-negative patients.
- Methacholine challenge testing and flow-volume loops aided in identifying VCD, with 60% of VCD-positive patients showing abnormal loops post-methacholine.
Conclusions:
- Paradoxical inspiratory vocal cord closure (VCD) is a frequent finding in military patients with exertional dyspnea.
- Flexible laryngoscopy is an effective diagnostic tool for VCD.
- VCD should be strongly considered in the differential diagnosis of exertional dyspnea in military personnel.