Vocal Cord Dysfunction Mimicking Asthma: A Case Report

似氣喘病之聲帶功能異常：病例報告

盧建宏(Chien-Hung Lu) ； 王鴻昌(Hong-Chung Wang) ； 盧朝勇(Jau-Yeong Lu)

《胸腔醫學》 17卷3期 (2002/09) Pp. 297-302

摘要

聲帶功能異常是指在呼吸時，聲帶不正常地內收而導致氣流在喉部受阻。文獻上之病例大都為年輕女性，而且常被誤診為氣喘病。我們報告一罕見之老年男性聲帶功能異常之病例。一名年齡七十五歲之病人患有間歇性呼吸困難及胸悶六年之時間，被誤診為有氣喘病三年。雖然已接受氣管擴張劑與類固醇之積極治療，其病情並無改善。在最近的一次住院當中，支氣管誘發測驗顯示陰性反應。我們利用電子腳踏車來進行運動測驗，以誘發病患症狀發作。結果發現在吸氣期，其氣流與肺容積曲線圖有明顯之截平現象。在症狀發作時，氣管鏡檢查亦發現在吸氣期，聲帶有反常之內收現象，這更進一步幫我們確定診斷。之後病患接受精神科醫師所提供之喉部放鬆技巧及投予抗焦慮藥物，其生活品質獲明顯之改善。

關鍵字

氣喘病 ； 氣流與肺容積曲線圖 ； 聲帶功能異常

並列摘要

Vocal cord dysfunction (VCD) is a respiratory condition characterized by an adduction of the vocal cords, with a resultant airflow limitation at the level of the larynx. The previously reported cases with VCD have been predominantly young women. We herein present an uncommon, elderly case of VCD. This 75-year-old male had been suffering from intermittent inspiratory difficulty and chest discomfort for about 6 years. He had been diagnosed as having asthma for 3 years. Since diagnosis, he has had repeated exacerbations despite aggressive therapy that included corticosteroids, theophylline, and inhaled bronchodilators. However, in the current evaluation, a methacholine inhalational challenge revealed a negative result. The spirometry indicated remarkable flattened inspiratory loops on the flow volume curve while he was experiencing acute symptoms aggravated by an exercise test. Direct visualization, by bronchoscopy, of paradoxical adductive vocal cords movement in the inspiratory phase during a symptomatic period further confirmed the diagnosis. After undergoing maneuvers directed at laryngeal relaxation, and receiving anxiolytic agents from the psychiatrist, he has demonstrated a significantly improved quality of life.

並列關鍵字

asthma ； flow volume curve ； vocal cord dysfunction