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Exercise-induced bronchoconstriction and vocal cord dysfunction: two sides of the same coin?
Kenneth W Rundell1, Pnina Weiss
1Pharmaxis Inc., One East Uwchlan Avenue, Suite 406, Exton, PA 19341, USA. Ken.rundell@pharmaxis.com
Current Sports Medicine Reports
|January 15, 2013
Summary
Differentiating exercise-induced bronchoconstriction (EIB) and vocal cord dysfunction (VCD) is challenging, as both cause exercise-induced dyspnea and can coexist. Diagnosis often requires challenge tests and laryngoscopy, as history alone is insufficient.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Sports Medicine
Background:
- Exercise-induced dyspnea and wheeze are common patient complaints.
- Exercise-induced bronchoconstriction (EIB) and vocal cord dysfunction (VCD) are primary causes.
- Differentiating EIB and VCD is difficult due to overlapping symptoms and potential comorbidity.
Purpose of the Study:
- To examine the current understanding of EIB and VCD.
- To discuss the mechanisms, prevalence, diagnosis, and treatment of EIB and VCD.
- To highlight the diagnostic challenges in distinguishing between EIB and VCD.
Main Methods:
- Review of current understanding of EIB and VCD.
- Discussion of diagnostic approaches including challenge tests and flexible laryngoscopy.
- Analysis of mechanisms, prevalence, and treatment strategies.
Main Results:
- EIB involves lower airway constriction due to dry air/allergens, potentially with or without asthma.
- VCD involves paradoxical vocal cord adduction, causing inspiratory stridor, and can be comorbid with asthma/EIB.
- EIB symptoms peak post-exercise, while VCD occurs during exercise and resolves quickly.
Conclusions:
- History alone is inadequate for differentiating EIB and VCD.
- Objective diagnostic tools like challenge tests and laryngoscopy are often necessary.
- Understanding the distinct and overlapping features is crucial for accurate diagnosis and management.
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