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Vocal cord dysfunction masquerading as exercise-induced asthma. a physiologic cause for "choking" during athletic
1Division of Pulmonary and Critical Care Medicine of University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-5067, USA.
Summary
Elite athletes experiencing exercise-induced dyspnea may have psychogenic vocal cord dysfunction, not asthma. Differentiating these conditions is crucial for accurate diagnosis and effective treatment strategies.
Area of Science:
- Sports Medicine
- Pulmonology
- Otolaryngology
Background:
- Exercise-induced bronchospasm is common in athletes, impacting performance.
- Other conditions can mimic exercise-induced asthma symptoms.
- Accurate differentiation is vital for appropriate patient management.
Purpose of the Study:
- To describe a distinct syndrome in elite athletes presenting with exertional dyspnea.
- To differentiate psychogenic vocal cord dysfunction from exercise-induced asthma.
- To highlight the importance of thorough clinical and physiological evaluation.
Main Methods:
- Case series of seven elite athletes with psychogenic vocal cord dysfunction.
- Clinical and physiological evaluations, including bronchoprovocations (cold air hyperventilation, methacholine, exercise).
- Direct laryngoscopy in select subjects.
Main Results:
- Patients exhibited unique histories and symptoms inconsistent with typical exercise-induced asthma.
- Symptoms occurred during exercise, with variable responses to identical stimuli.
- Poor response to asthma medications and confirmed variable extrathoracic airway obstruction via bronchoprovocation.
Conclusions:
- Psychogenic vocal cord dysfunction can present as exertional dyspnea in athletes, mimicking asthma.
- Atypical exertional complaints necessitate comprehensive clinical and physiological assessment.
- Exercise and airway obstruction alone do not confirm an asthma diagnosis.