Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist

Abstract

This case concerns an elite road cyclist who complained of occasional dyspnoea and inspiratory difficulty during intense exercise. Clinical examination was normal and the final diagnosis was vocal cord dysfunction, a paradoxical closure of the vocal cords during inspiration which is highly associated with inspiratory stridor at high rates of ventilation. Awareness by the sports physician of this not uncommon condition is important to avoid misdiagnosis.

Exercise-induced laryngeal obstructions: prevalence and symptoms in the general public

“…The increased odds ratio for females having EILOs corroborated that reported cases predominantly concerns females [13][14][15][16][17][18][19][20][21][22]. The reason for this is not known, but the significantly higher odds ratio for females with symptoms participating on day 2 could partly explain this.…”

Multidisciplinary approach to vocal cord dysfunction diagnosis and treatment in one session: A single institutional outcome study

“…Besides identifying characteristic manifestations of VCD in the patient's history, practitioners may make the diagnosis of VCD based on pulmonary function tests displaying a blunted inspiratory loop in the presence of a normal expiratory loop and on laryngoscopic visualization of abnormally adducting vocal cords on inspiration during an acute episode of VCD. Because inspiratory adduction is rarely visualized, exercise laryngoscopy may be organized to visualize inspiratory adduction [25,26]. One possible finding associated with VCD is supraglottic compression due to hyperfunction during phonation.…”

Diagnostic Criteria for the Classification of Vocal Cord Dysfunction

“…57 This clinical presentation was reported in several more cases. [58][59][60][61][62][63] In 1996, McFadden and Zawadski 29 reported seven elite athletes with a "choking" sensation during exercise, normal baseline pulmonary function testing (PFT), and negative bronchoprovocation. The diagnosis was made during either laryngoscopy or postexercise FVL fl attening.…”