McFadden E R, Zawadski D K
Division of Pulmonary and Critical Care Medicine of University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-5067, USA.
Am J Respir Crit Care Med. 1996 Mar;153(3):942-7. doi: 10.1164/ajrccm.153.3.8630577.
Exercise-induced bronchospasm is a common clinical problem that is particularly troubling for patients who engage in strenuous physical activity, such as athletes. When such individuals develop this condition, the associated airway narrowing can materially interfere with performance; however, events other than asthma can also produce these symptoms and their differentiation is essential for proper treatment. The present report describes seven elite athletes with psychogenic vocal cord dysfunction who presented with acute dyspnea during sporting competitions. Although the combination of exertion and wheezing suggested the diagnosis of exercise-induced asthma, the patients' histories were sufficiently unique so as to represent a recognizable syndrome. The patients underwent clinical physiologic evaluations including bronchoprovocations with isocapnic hyperventilation of frigid air, methacholine and/or exercise. Direct laryngoscopy was also performed in some subjects. The findings that differentiated these patients from asthmatics were a lack of consistency in the development of symptoms when exposed to identical stimuli, the onset of breathing difficulties during exercise, and poor therapeutic and prophylactic responses to anti-asthma medications. The clinical impression of a functional disorder was confirmed by bronchoprovocations that demonstrated the variable extrathoracic airway obstruction of vocal cord dysfunction. Patients with atypical exertional complaints require careful clinical and physiologic evaluation. The mere association of exercise and airway obstruction is not sufficient to establish the diagnosis of asthma.
运动诱发性支气管痉挛是一个常见的临床问题，对于从事剧烈体育活动的患者，如运动员，尤其困扰。当这些人出现这种情况时，相关的气道狭窄会严重影响运动表现；然而，除哮喘外的其他情况也可产生这些症状，对其进行鉴别对于正确治疗至关重要。本报告描述了七名患有心因性声带功能障碍的精英运动员，他们在体育比赛中出现急性呼吸困难。尽管运动和喘息的组合提示运动诱发性哮喘的诊断，但这些患者的病史足够独特，足以代表一种可识别的综合征。患者接受了临床生理评估，包括用冷空气等碳酸过度通气、乙酰甲胆碱和/或运动进行支气管激发试验。部分受试者还进行了直接喉镜检查。将这些患者与哮喘患者区分开来的发现是，暴露于相同刺激时症状发展缺乏一致性、运动期间出现呼吸困难以及对抗哮喘药物的治疗和预防反应不佳。支气管激发试验证实了功能性障碍的临床印象，该试验显示了声带功能障碍导致的可变胸外气道阻塞。有非典型运动相关症状的患者需要仔细的临床和生理评估。仅仅运动与气道阻塞相关并不足以确立哮喘的诊断。
