Pneumologie (Stuttgart, Germany) · 1997
[Vocal cord dysfunction, an important differential diagnosis of severe and implausible bronchial asthma].
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Kenn K, Schmitz M
Аннотация
BACKGROUND: For asthmatics who show-despite of all available therapeutic efforts-an unsatisfactory clinical course in- or exspiratory vocal cord dysfunctions are an important diagnostic consideration. Aside from some case reports, there is only one major study, presenting a prevalence of > 30% in subjects admitted because of refractory asthma.
PATIENTS AND METHODS: The question was whether this phenomenon could also be found in our patients, mostly in- or extrinsic asthmatics. In cases suspicious for VCD or with an unexplainable asthma course, we performed videotaped laryngoscopy, including exposure to questionable provocing irritants.
RESULTS: In 14 months, we detected VCD in 16 patients by laryngoscopy and spirometry at the time of severe dyspnea. Subjects were predominantly women. Our therapeutical approach included: explanation of their videotape, speech therapy, breathing techniques and psychological support. In patients, pretreated with systemic corticosteroids, the dose could be reduced remarkably. A benefit 3 month after diagnosis could be shown using a life-quality-questionnaire.
CONCLUSIONS: Screening for VCD in patients with unplausible, refractory asthma and other unexplained dyspnea- or wheezing attacks is an important diagnostic consideration in order to prevent unnecessary medical treatment or drug related side-effects and to introduce a specific therapeutical concept.
PATIENTS AND METHODS: The question was whether this phenomenon could also be found in our patients, mostly in- or extrinsic asthmatics. In cases suspicious for VCD or with an unexplainable asthma course, we performed videotaped laryngoscopy, including exposure to questionable provocing irritants.
RESULTS: In 14 months, we detected VCD in 16 patients by laryngoscopy and spirometry at the time of severe dyspnea. Subjects were predominantly women. Our therapeutical approach included: explanation of their videotape, speech therapy, breathing techniques and psychological support. In patients, pretreated with systemic corticosteroids, the dose could be reduced remarkably. A benefit 3 month after diagnosis could be shown using a life-quality-questionnaire.
CONCLUSIONS: Screening for VCD in patients with unplausible, refractory asthma and other unexplained dyspnea- or wheezing attacks is an important diagnostic consideration in order to prevent unnecessary medical treatment or drug related side-effects and to introduce a specific therapeutical concept.