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Extrathoracic Obstruction and Hypoxemia Occurring During Exercise in a Competitive Female Cyclist*

Hans Haverkamp; Jordan Miller; Joshua Rodman; Lee Romer; David Pegelow; Marcus Santana; Jerome Dempsey
Author and Funding Information

*From the Department of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI.

Correspondence to: Hans C. Haverkamp, MS, 504 N Walnut St, Madison, WI 53726; e-mail: hchaverkamp@students.wisc.edu



Chest. 2003;124(4):1602-1605. doi:10.1378/chest.124.4.1602
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A 22-year-old competitive female cyclist complained of cough, chest tightness, and wheeze during high-intensity exercise that had previously been diagnosed as exercise-induced bronchospasm (EIB). A loud stridor, a sensation of her “throat closing,” and severe dyspnea developed during maximal cycling exercise with concomitant reductions in both inspiratory and expiratory flow rates. A decrease of 25 L/min (26%) in minute ventilation and arterial hypoxemia (Pao2 decrease, 93 to 76.5 mm Hg) resulted from this obstruction. Spontaneous tidal flow-volume loops (FVLs) during exercise exhibited a sawtooth pattern during inspiration, and substantial drops in flow rates after the stridor developed. However, maximal FVLs were unchanged from baseline following exercise, indicating that the obstruction was not EIB. We suggest that the continuous measurement of spontaneous breath-by-breath tidal FVLs may be a useful diagnostic tool for the identification of exercise-induced extrathoracic obstruction. Additionally, extrathoracic obstruction should be considered as an uncommon but potential cause of inadequate ventilation and arterial hypoxemia during exercise.

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