TY - JOUR
T1 - Vocal cord dysfunction presenting as 'steroid-dependent' asthma
AU - Knoell, Daren L.
AU - Marsh, Clay B.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 1997
Y1 - 1997
N2 - Objective: To describe a case of paroxysmal vocal cord dysfunction (PVCD) in a patient presenting with an initial diagnosis of severe asthma. Case Summary: A 42-year-old obese white woman with a 5-year history of severe asthma symptoms was referred to The Ohio State University Comprehensive Asthma Outpatient Clinic. The patient said she had experienced frequent 'asthma attacks' despite increased use of multiple asthma medications. Additionally, she often required nebulization therapy with bronchodilators and supplemental oxygen, and had a variable response. During the clinic visit, the patient presented with clear airways uncharacteristic of a person with severe asthma. A diagnosis of PVCD was made on the basis of results of videolaryngostroboscopy, and asthma medications were gradually discontinued. Setting: The Ohio State University Comprehensive Asthma Outpatient Clinic. Discussion: Patients with PVCD often present with symptoms characteristic of asthma. As a result, misdiagnosis of severe asthma often occurs, and the patient undergoes unnecessary treatment. The cornerstone for diagnosis of PVCD is laryngoscopic viewing of the adducted vocal cord during an acute attack. Following diagnosis, treatment for PVCD includes a multidisciplinary approach that includes speech therapy and psychiatric counseling. Pharmacologic therapy in patients with pure PVCD is not required, thus preventing medication-related morbidity and associated costs. Conclusions: PVCD must be considered in patients who are refractory to asthma therapy and have dyspneic symptoms out of proportion to observed clinical findings. We suggest that all patients with episodes of acute asthma undergo objective testing to document acute airway obstruction. Oral corticosteroid therapy and treatment-associated morbidity can be avoided in patients with PVCD if the appropriate diagnosis is made early.
AB - Objective: To describe a case of paroxysmal vocal cord dysfunction (PVCD) in a patient presenting with an initial diagnosis of severe asthma. Case Summary: A 42-year-old obese white woman with a 5-year history of severe asthma symptoms was referred to The Ohio State University Comprehensive Asthma Outpatient Clinic. The patient said she had experienced frequent 'asthma attacks' despite increased use of multiple asthma medications. Additionally, she often required nebulization therapy with bronchodilators and supplemental oxygen, and had a variable response. During the clinic visit, the patient presented with clear airways uncharacteristic of a person with severe asthma. A diagnosis of PVCD was made on the basis of results of videolaryngostroboscopy, and asthma medications were gradually discontinued. Setting: The Ohio State University Comprehensive Asthma Outpatient Clinic. Discussion: Patients with PVCD often present with symptoms characteristic of asthma. As a result, misdiagnosis of severe asthma often occurs, and the patient undergoes unnecessary treatment. The cornerstone for diagnosis of PVCD is laryngoscopic viewing of the adducted vocal cord during an acute attack. Following diagnosis, treatment for PVCD includes a multidisciplinary approach that includes speech therapy and psychiatric counseling. Pharmacologic therapy in patients with pure PVCD is not required, thus preventing medication-related morbidity and associated costs. Conclusions: PVCD must be considered in patients who are refractory to asthma therapy and have dyspneic symptoms out of proportion to observed clinical findings. We suggest that all patients with episodes of acute asthma undergo objective testing to document acute airway obstruction. Oral corticosteroid therapy and treatment-associated morbidity can be avoided in patients with PVCD if the appropriate diagnosis is made early.
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U2 - 10.1177/875512259701300304
DO - 10.1177/875512259701300304
M3 - Article
AN - SCOPUS:0030976149
SN - 8755-1225
VL - 13
SP - 118
EP - 121
JO - Journal of Pharmacy Technology
JF - Journal of Pharmacy Technology
IS - 3
ER -