Emotional laryngeal wheezing: a new syndrome

A 41-yr-old psychologically disturbed woman presented with attacks of paroxystic dyspnea, laborious expiration, cough, and expiratory wheezing. She had been treated for bronchial asthma and had developed an iatrogenic Cushing's syndrome. Wheezing had maximal intensity over the larynx, and fiberoptic bronchoscopy showed an almost closed glottis orifice during its production. Lung function tests were normal both before and during the attacks. Inhalation challenge tests with acetylcholine and histamine were negative. During the attacks the patient breathed near residual volume, and tidal flows reached the maximal flow-volume envelope. We suggest that wheezing was produced by high flows passing through a narrow glottis orifice. The association of expiratory wheezing of laryngeal origin with normal overall lung function should be kept in mind, because it can be easily confounded with bronchial asthma, and result in therapeutic errors.