A 16-year-old female basketball player neared with a 2 1/2-year history of exercise-induced exact dyspnea.

A 16-year-old female basketball player neared with a 2 1/2-year history of exercise-induced exact dyspnea, stridor, and mild wheezing that did not suit to prophylactic treatment with [beta]-agonists and cromolyn Spirometric data at quiet were normal, but flow-volume apertures during exercise suggested a variable extrathoracic obstruction. Laryngoscopic evaluation while the patient was riding an exercise bicycle demonstrated an abnormal motion of the arytenoid region causing obstruction of the airway during inspiration. The vocal cords mov normally. This patient demonstrates the capacity of supraglottic tissue to close the airway during exercise as a cause for exercise-induced dyspnea and stridor. Patients with this disorder may be misdiagnosed as having exercise-induced asthma.

Functional disorders of the vocal cords may mimic attacks of bronchial asthma,[1-3] and variable vocal cord dysfunction may instant as exercise-induced asthma.[4] A late report describes stridor at interval in a 75-year-old woman with inspiratory airflow obstruction suitable to an abnormal motion of the arytenoid region.[5] We now report similar findings masquerading as exercise-induced asthma in an adolescent female athlete.

Case Report

A 16-year-old female high drill athlete presented to the clinic with a 2 1/2-year history of worsening episodic dyspnea occurring during participation in competitive athletics. She first experienced exercise-associated dyspnea at the age of 7 years when she attempted to hurry a mile. This exertional dyspnea progressively increased from one side of to the other the next few years, leading her family physician to make a diagnosis of exercise-induced asthma 2 years before our evaluation. He prescribed therapy with albuterol via a metereddose inhaler for use prior to exercise and when symptoms cause to growed during exercise. Initially, the patient reported that the medication was effective, yet over the ensuing 2 years, she build that it neither prevented nor relieved symptoms. he patient complained that vigorous exercise caused symptoms of throat tightness, dyspnea, and wheezing that were worse when the air was burning and humid. In contrast, brumal air did not exacerbate symptoms. She denied nasal symptoms, ocular symptoms, and cough She had no psychiatric history or history of emotional distress.

The patient was given a Wright peak deliquesce mini-meter (Keller Medical Specialties, Inc.) that she used the two at rest and with exercise for 26 consecutive days. Average resting values in the morning and evening were 410 L/min and 390 L/min, respectively. Despite prophylactic treatment with albuterol or cromolyn 15 min prior to basketball games, her peak come measurements fell to 270 L/min after and nothing else 5 min of play. A formal exercise proof was performed because of the failure of her condition to be agreeable to to the inhaled medications, the history of throat tightness with exercise, and increased chest symptoms with elevated extent temperature and humidity. A marked flattening of the inspiratory crook developed after about 5 min of exercise, consistent with a variable extrathoracie obstruction.

To identify the cause of the extrathoracic obstruction, the patient underwent conjoined direct fiberoptic laryngoscopy and pulmonary function testing at ease and while exercising on a bicycle. Abnormal motion of the arytenoid region occurr sole after maximal exercise and was associated with stridor (Fig 1) reproducing the patient's complaints. The corresponding flow-volume noose demonstrated a cutoff and flattening of the inspiratory arm consistent with a variable extrathoracic obstruction (Fig 2) No decrease in grow rates was seen during the formal exercise testing, which was performed twice, and the patient was referr to the language therapy department for evaluation.

united month after the discovery of the abnormal motion of the arytenoid region, the patient underwent a methacholine bronchial provocation challenge to evaluate bronchial hyperresponsiveness. The ordeal was positive at 10 mg/ml (92 cumulative breath units), with a fall in [FEVsub1] of 38 percent At that time, the patient reported improvement in exercise-related dyspnea and stridor after the initiation of dialect therapy.

Discussion

This adolescent female athlete had symptomatic exercise-associated stridor that was initially diagnosed as exercise-induced asthma unless was caused by an abnormal motion of the arytenoid flocks There are many reports of upper airway obstruction without evidence of organic abnormalities being attributed to a paradoxical motion of the vocal cords.[1-3] There have been pair recent reports of functional upper airway obstruction not related to abnormal vocal cord motion. Bronchoscopy in a 15-year-old lad revealed pharyngeal constriction associated with a deformed epiglottis.[6] The other patient was a 75-year-old woman who had evidence of abnormal motion of the arytenoid region as the cause of her upper airway obstruction at rest[5] To our knowledge, our case demonstrates the first report of the same abnormal arytenoid motion occurring and nothing else during exercise (Fig 1 and 2)

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