Case history
Case history #1
A 19-year-old female athlete has been referred by a pulmonologist for breathing attacks during running that have not responded to asthma inhalers. The pulmonologist diagnosed persistent stable asthma, with additional dyspnea while running, suspected to be due to PVFM/ILO, seasonal allergies, and chronic sinusitis. He recommended continued use of fluticasone/salmeterol and albuterol inhalers, cetirizine for allergies, and evaluation to rule out PVFM/ILO. The patient reports that her primary triggers for breathing attacks that do not respond to inhalers include high-intensity sprinting drills, time trials, and competitive athletics. The breathing attacks did not occur in high school but began at college. She has lost 3 seconds off her best running time and is at risk of not making the winter travel training team. Asthma symptoms are described as coughing, wheezing, and feeling winded. She describes her breathing difficulties while running as difficulty getting air in, with general overall body tightness.
Case history #2
A 54-year-old woman with a long history of breathing attacks to multiple triggers reports a 2-year history of breathing difficulties that began after mold exposure in the workplace following water damage to the property. At the time of building repair, she started having breathing difficulties and hoarseness and has since been hospitalized twice for breathing attacks. Additional triggers are identified as smoke, perfumes, cleaners, cold, and dust. She has been diagnosed with asthma but has not been investigated with exercise bronchoprovocation or had a cardiac workup. Her current medications include hydrochlorothiazide, fexofenadine, montelukast, tiotropium, fluticasone/salmeterol, azelastine, cromolyn sodium, and budesonide, and omalizumab injections. The patient is unable to go out in public where triggers exist.
Other presentations
Several other cases of paradoxical vocal fold motion (intermittent laryngeal obstruction) (PVFM/ILO) have been documented that were unrelated to irritable larynx, irritant exposure, athletics, or neurologic illness. These include PVFM/ILO and feeding difficulty following pediatric cardiac surgery, 1 case of cough and PVFM/ILO after an inlet patch of gastric mucosa in the upper esophagus, 2 cases of PVFM/ILO post mitral valve replacement, several other postoperative cases of PVFM/ILO, and documentation of postintubation phonatory insufficiency.[7][8][9][10][11][12][13][14][15][16][17] There has also been report of mass psychogenic illness in a female cohort with acute stridor.[18]
Use of this content is subject to our disclaimer