0
Clinical Investigations: AIRWAYS DISEASE |

Vocal Cord Dysfunction in Patients With Exertional Dyspnea*

Michael J. Morris, LTC, MC, USA; Leonard E. Deal, MAJ, MC, USA; Donald R. Bean, MS; Vincent X. Grbach, MAJ, MC, USA; Julia A. Morgan, LTC, MC, USA
Author and Funding Information

*From the Pulmonary Disease/Critical Care Service, Department of Medicine (LTC Morris, MAJ Deal, MAJ Grbach, and LTC Morgan), and Speech Pathology, Otolaryngology/Head and Neck Service (Mr. Bean), Brooke Army Medical Center, Fort Sam Houston, TX.

Correspondence to: LTC Michael J. Morris, Pulmonary/Critical Care Service (MCHE-MDP), Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234-6200; e-mail: Michael.Morris@cen.amedd.army.mil



Chest. 1999;116(6):1676-1682. doi:10.1378/chest.116.6.1676
Text Size: A A A
Published online

Study objectives: To evaluate patients for vocal cord dysfunction (VCD) in a military population presenting with symptoms of exertional dyspnea.

Design: Cross-sectional, controlled study.

Setting: Pulmonary disease clinic at an army tertiary care center.

Patients: Forty military patients with complaints of exertional dyspnea and 12 military asymptomatic control subjects.

Intervention: Patients underwent direct visualization of vocal cords with flexible laryngoscopy before and after exercise to evaluate for presence of inspiratory vocal cord adduction.

Measurements and results: Complete evaluation for all patients consisted of spirometry with flow-volume loops, lung volumes, diffusing capacity, and maximum voluntary ventilation at rest; chest radiograph; methacholine bronchoprovocation testing; and a maximal cardiopulmonary exercise test with expiratory gas analysis. Fifteen percent of patients studied prospectively were found to have VCD, whereas all control subjects were negative for VCD. There was minimal difference in pulmonary function testing between VCD-positive and VCD-negative patients, whereas control subjects had higher spirometric values. Twenty percent of VCD-positive patients had abnormal flow-volume loops compared with 14% of patients without VCD, but after methacholine, 60% of VCD-positive patients developed abnormal flow-volume loops. In the VCD-positive group, 60% had a positive methacholine response, but there was less decrease in FEV1/FVC ratio compared with either VCD-negative patients or control subjects.

Conclusions: Paradoxical inspiratory vocal cord closure is a frequent occurrence in patients with symptoms of exertional dyspnea and should be strongly considered in their evaluation.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543