Dyspnea in athletes – VCD or asthma? K. Kenn, I. Heinzelmann Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land, Schönau am Königssee
DOI 10.5414/ATP37374
Abstrakt
Similarity of symptoms between vocal cord dysfunction (VCD) and exercise-induced asthma (EIA) may confuse the differential diagnosis of exercise-induced dyspnea. Both diseases are characterized by dyspnea attacks, but there are typical distinctions between these two conditions: patients with VCD often localize their dyspnea in the throat and symptoms are mainly limiting inspiration. Patients with EIA complain of dyspnea that is localized in the chest and limiting expiration. VCD-symptoms develop within seconds, which is felt to be potentially life-threatening. A combination of asthma and VCD is often and confuses the clinical picture. Dyspnea and inspiratory stridor in VCD are caused by a paradoxical adduction of the vocal cords during inhalation (occasionally upon exhalation), activated individually by exercise, inhaled stimuli or mental stress. A significant proportion of athletes may be affected by VCD. In spirometric measurements during exercise, 111 out of 370 elite athletes showed symptoms of EIA, 19 inspiratory stridor (indication of VCD). Women have been more affected by VCD (m : f = 1 : 18). Endoscopy even better endospirometry, a combination of simultaneous demonstration of endoscopy and spirometry may be seen as the gold standard for diagnosis of VCD. Positive endospirometry at the time of symptoms gives evidence for VCD, but endospirometry never excludes VCD as the correct diagnosis due to the intermitted appearance of dyspnoea. VCD is often misdiagnosed as asthma and might result in unnecessary and ineffective medication. Individuals with VCD should be treated with breathing therapy and special education leading to an understanding of the cause of their dyspnea. A higher awareness of VCD in sport medicine professionals, who are often the first to evaluate individuals with this disorder, could allow an immediate identification and the introduction to target-oriented therapy.
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