[Functional obstruction of the upper airway]. 1994

G C Montiel, and S A Quadrelli, and G B Semeniuk, and A J Roncoroni
Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires.

Laryngeal wheezing caused by emotional stress is usually confused with that caused by bronchospasm and diagnosed as asthma, a well known emotionally influenced entity. Therefore, it is treated with bronchodilators, including corticosteroids, frequently resulting in a iatrogenic Cushing's syndrome. This case report concerns a patient initially considered to have bronchial asthma. Physiological and endoscopic studies allowed us to exclude this disease, as well as any organic obstruction of the upper and lower airway. Flow-volume curve showed that the tidal volume (VT) loop was displaced towards RV during the crisis and the expiratory flow of the VT reached the envelope of the maximal expiratory flow (Fig. 1). Direct larynx observation during fiberoptic bronchoscopy showed not only expiratory but also inspiratory vocal cords adduction. A diagnosis of emotional laryngeal wheezing was made. Excluding asthma, bronchodilators were progressively discontinued. She started to receive alprazolam and psychotherapy and during one year of follow-up she remained symptomless. Two mechanisms may be present in our patient: partial inspiratory adduction of vocal cords and breathing at low lung volume. Despite reported dissimilarities between these two mechanisms both seem to have a similar emotional origin.

UI MeSH Term Description Entries
D008449 Maximal Expiratory Flow-Volume Curves Curves depicting MAXIMAL EXPIRATORY FLOW RATE, in liters/second, versus lung inflation, in liters or percentage of lung capacity, during a FORCED VITAL CAPACITY determination. Common abbreviation is MEFV. Maximal Expiratory Flow Volume Curves
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D012135 Respiratory Sounds Noises, normal and abnormal, heard on auscultation over any part of the RESPIRATORY TRACT. Breathing Sounds,Crackles,Lung Sounds,Pleural Rub,Rales,Rhonchi,Stridor,Wheezing,Breathing Sound,Crackle,Lung Sound,Pleural Rubs,Rale,Respiratory Sound,Rhonchus,Rub, Pleural,Sound, Breathing,Sound, Lung,Sound, Respiratory,Sounds, Breathing,Sounds, Lung,Stridors,Wheezings
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000402 Airway Obstruction Any hindrance to the passage of air into and out of the lungs. Choking,Airway Obstructions,Obstruction, Airway,Obstructions, Airway

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