[BRONCHIAL ASTHMA WITH VOCAL CORD DYSFUNCTION DIFFERENTIATED FROM SEVERE ASTHMA BY BRONCHOSCOPY]

Area of Science:

• Pulmonology
• Otolaryngology
• Respiratory Medicine

Background:

• Vocal cord dysfunction (VCD) is often psychogenic but can co-exist with or mimic severe asthma.
• Differentiating VCD from asthma is crucial for effective treatment, as standard asthma therapies may be ineffective for VCD.

Purpose of the Study:

• To present a case of VCD misdiagnosed as intractable severe asthma.
• To emphasize the importance of considering VCD in the differential diagnosis of severe asthma.
• To illustrate diagnostic methods for VCD in this clinical context.

Main Methods:

• Clinical presentation of dyspnea despite asthma treatment.
• Diagnostic workup including computed tomography (CT) of neck and chest, fractional exhaled nitric oxide (FeNO) measurement, and pulmonary function tests (PFTs) with flow-volume loops.
• Methacholine inhalation challenge combined with bronchoscopy during an acute attack.

Main Results:

• The patient exhibited inspiratory stridor and expiratory wheezes, with normal CT scans and FeNO levels.
• PFTs showed a normal expiratory loop and an inspiratory loop flattening post-methacholine.
• Bronchoscopy confirmed inspiratory vocal cord closure during an attack, leading to a VCD diagnosis.

Conclusions:

• Vocal cord dysfunction should be strongly considered in patients with refractory asthma-like symptoms.
• A combination of methacholine challenge and bronchoscopy can be invaluable for diagnosing VCD.
• Respiratory rehabilitation and specific breathing techniques effectively managed the patient's VCD symptoms.