Komiyama Kenichiro, Soma Machika, Nakagome Kazuyuki, Miyauchi Sachiko, Uchida Yoshitaka, Soma Tomoyuki, Nakamura Hidetoshi, Nagata Makoto
Department of Respiratory Medicine, Saitama Medical University.
Allergy Center, Saitama Medical University.
Arerugi. 2021;70(1):33-38. doi: 10.15036/arerugi.70.33.
Although an important cause of vocal cord dysfunction (VCD) is psychogenic reaction, VCD may be associated with severe asthma and must be distinguished from the disease. A 30-years-old woman was admitted to our hospital with dyspnea despite treatment for asthma. Inspiratory stridor and expiratory wheezes were noted, and neck and chest computed tomography showed normal airways and lungs. Fractional exhaled nitric oxide levels were also normal. Pulmonary function test with a flow-volume loop curve showed normal expiratory loop with flattening of the inspiratory loop after methacholine inhalation. During the attack, bronchoscopy revealed the vocal cord closing with stridor during the inspiratory phase. Therefore, the patient was diagnosed with VCD. The dyspnea improved with respiratory rehabilitation and pursed-lip breathing. VCD should be considered in the differential diagnosis of intractable severe asthma. In this case, bronchoscopy and bronchial inhalation challenge with methacholine helped in the diagnosis.
尽管声带功能障碍（VCD）的一个重要原因是心理性反应，但VCD可能与重度哮喘相关，必须与该疾病相鉴别。一名30岁女性因哮喘治疗后仍有呼吸困难而入院。检查发现有吸气性喘鸣和呼气性哮鸣音，颈部和胸部计算机断层扫描显示气道和肺部正常。呼出一氧化氮分数水平也正常。吸入乙酰甲胆碱后进行的肺功能流量-容积环曲线测试显示呼气环正常，但吸气环变平。发作期间，支气管镜检查显示吸气期声带闭合并伴有喘鸣。因此，该患者被诊断为VCD。通过呼吸康复和缩唇呼吸，呼吸困难症状得到改善。在难治性重度哮喘的鉴别诊断中应考虑VCD。在这种情况下，支气管镜检查和乙酰甲胆碱支气管吸入激发试验有助于诊断。
