Chest
Volume 116, Issue 6, December 1999, Pages 1676-1682
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Clinical Investigations
Airways Disease
Vocal Cord Dysfunction in Patients With Exertional Dyspnea

https://doi.org/10.1378/chest.116.6.1676Get rights and content

Study objectives

To evaluate patients for vocal cord dysfunction (VCD) in a military population presenting with symptoms of exertional dyspnea.

Design

Cross-sectional, controlled study.

Setting

Pulmonary disease clinic at an army tertiary care center.

Patients

Forty military patients with complaints of exertional dyspnea and 12 military asymptomatic control subjects.

Intervention

Patients underwent direct visualization of vocal cords with flexible laryngoscopy before and after exercise to evaluate for presence of inspiratory vocal cord adduction.

Measurements and results

Complete evaluation for all patients consisted of spirometry with flow-volume loops, lung volumes, diffusing capacity, and maximum voluntary ventilation at rest; chest radiograph; methacholine bronchoprovocation testing; and a maximal cardiopulmonary exercise test with expiratory gas analysis. Fifteen percent of patients studied prospectively were found to have VCD, whereas all control subjects were negative for VCD. There was minimal difference in pulmonary function testing between VCD-positive and VCD-negative patients, whereas control subjects had higher spirometric values. Twenty percent of VCD-positive patients had abnormal flow-volume loops compared with 14% of patients without VCD, but after methacholine, 60% of VCD-positive patients developed abnormal flow-volume loops. In the VCD-positive group, 60% had a positive methacholine response, but there was less decrease in FEV1/FVC ratio compared with either VCD-negative patients or control subjects.

Conclusions

Paradoxical inspiratory vocal cord closure is a frequent occurrence in patients with symptoms of exertional dyspnea and should be strongly considered in their evaluation.

Section snippets

Materials and Methods

Any active-duty patient between the ages of 18 and 50 years referred to the Pulmonary Disease Clinic at Brooke Army Medical Center, Fort Sam Houston, TX, for evaluation of new symptoms of exertional dyspnea was considered eligible for the protocol. Exertional dyspnea was defined as shortness of breath that occurred primarily with running, a regular part of physical training for soldiers. Any patient with an established diagnosis of pulmonary or cardiac disease was excluded from the study. All

Results

A comparison was performed of the PFT results, methacholine testing, and CPEX between three groups of patients. A total of 10 patients were considered VCD positive based on findings with direct laryngoscopy. There was agreement between the pulmonologist and speech pathologist in all cases. In the initial symptomatic evaluation group, five patients were identified: two patients had characteristic findings with both pre- and postexercise laryngoscopy, whereas the remaining three patients were

Discussion

Research over the last 2 decades has resulted in a greater understanding of laryngeal dyskinesias to include paradoxical VCD. Only in the last few years has the concept of VCD as a cause of dyspnea been generally accepted by the medical community. Our present study examined VCD in a cohort of young military patients presenting with a primary complaint of exertional dyspnea and an inability to pass a required army physical fitness test. Many of the patients were referred to our clinic with a

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No outside funding from any source was received during completion ofthe project or preparation of the manuscript.

The opinions or assertions contained herein are the private views ofthe authors and are not to be construed as reflecting the opinion ofthe Department of the Army or the Department of Defense.

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