Dyspnea Clinical Trial
Official title:
Pulmonary Function Test, Bronchial Hyperresponsiveness and Quality of Life in Patients With Vocal Cord Dysfunction (VCD)
Vocal cord dysfunction is a rare clinical picture. It is labeled as a sudden and threatening dyspnea. Patients with VCD may also present cough, hoarseness, wheezing, and chest tightness, but an inspiratory stridor is the most common symptom. For this reason, such patients are often misdiagnosed with refractory asthma, because of poor response to steroids and bronchodilators. Diagnosis is suspected on clinical grounds and is confirmed with laryngoscopy. The therapy consists of education, speech therapy and if necessary psychotherapy. The purpose of the investigators' study is to characterize children, adolescents, and young adults with VCD, and the evaluation of predictors as atopy, bronchial hyperresponsiveness, and psychiatric features.
VCD appears to be significantly more common among females. The episode of dyspnea underlies
the paradoxical, intermittent adduction of the vocal cords during inspiration. Methacholine
challenge testing combined with laryngoscopy is useful in differentiating vocal cord
dysfunction from asthma during the asymptomatic period.
In one visit patients will be characterized with a questionnaire based on the ISAAC
questionnaire. Furthermore, FeNO, eCO, skin prick testing and total serum IgE will be
examined. The psychiatric condition of patients will be determined by CBCL/6-18 and
YSR/11-18 behavior questionnaires. After initial fiberoptic laryngoscopy and pulmonary
function testing, bronchoprovocation is performed using nebulized methacholine at increasing
doses, until a 20% decline in the forced expiratory volume in 1 second is achieved
(PD20FEV1). Each methacholine testing will be followed by a second laryngoscopy and
pulmonary function testing. The visualization of paradoxical vocal cord motion during
inspiration will be recorded.
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