1/18. exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm. BACKGROUND: patients with exercise-induced laryngochalasia present with dyspnea and stridor during exercise. Symptoms are due to a subtotal occlusion of the larynx resulting from mucosal edema from the aryepiglottic folds being drawn into the endolarynx. methods: We report on three patients with exercise-induced bronchospasm, refractory to standard therapy. RESULTS: spirometry with flow-volume loops revealed truncation of the inspiratory limb. Abnormal movement of the arytenoid region was visualized on laryngoscopy. A diagnosis of exercise-induced laryngochalasia was made. CONCLUSIONS: Evaluation of laryngeal motion in patients with refractory exercise-induced bronchospasm is important. Surgical correction with laser laryngoplasty is effective in carefully selected cases. ( info) |
2/18. Beneficial effect of combination therapy with ozagrel and pranlukast in exercise-induced asthma demonstrated by krypton-81 m ventilation scintigraphy--a case report. INTRODUCTION: We evaluated the effect of combination therapy with thromboxane a2 synthesis inhibitor and leukotriene receptor antagonist in a patient with exercise-induced asthma using krypton-81 m ventilation scintigraphy. CLINICAL PICTURE: In a patient with exercise-induced asthma, we found exercise-induced abnormalities of respiratory function test and ventilation scintigraphy, and increases in plasma concentrations of thromboxane b2 and leukotriene c4 with exercise. TREATMENT: A thromboxane a2 synthesis inhibitor (ozagrel) and a leukotriene receptor antagonist (pranlukast) were prescribed. OUTCOME: After treatment for 2 weeks, abnormalities of respiratory function test and ventilation scintigraphy improved. CONCLUSIONS: The combination therapy with ozagrel and pranlukast might be useful for the relief of symptoms in patients with exercise-induced asthma, and krypton-81 m ventilation scintigraphy could be a useful tool for visible evaluation of treatment. ( info) |
3/18. exercise-induced asthma (EIA) after walking: a case report. A case in which exercise-induced asthma (EIA) was provoked at an intensity of less than 100 beats/min is discussed. EIA was provoked by a 12-minute walk test. Earlier tests using walking on other subjects had not produced such a result. It is therefore vital to teach asthmatics to monitor their pulmonary response at regular intervals to avert serious attacks in activities of daily living. ( info) |
4/18. Effects of the biopsychosocial approach (BPSA) on exercise-induced asthma (EIA). The Biopsychosocial Approach (BPSA) is a treatment program for allergic patients which includes therapy for psychological, behavioral and social factors as well as for physical problems, following basic principles of psychoneuroimmunology. BPSA was applied to patients with bronchial asthma and favorable results were obtained. The mechanism of the therapeutic effects of BPSA included normalization of the patient's autonomic nervous function, levels of blood histamine, and circadian rhythm of lymphocyte activity. BPSA was also used in patients with exercise induced asthma (EIA) and the same parameters were evaluated. Results showed that patients with EIA recovered physiological homeostasis after BPSA therapy normalized blood levels of histamine and substance p (SP), skin reactions to histamine and SP, and autonomic nervous function. We conclude that BPSA is effective for treating patients with EIA. ( info) |
5/18. Bronchial involvement in the cramp-fasciculation syndrome. BACKGROUND/AIMS: Cramp-fasciculation syndrome (CFS) is an acquired, chronic, usually benign and rather heterogeneous condition with isolated fasciculations and muscle cramps generally induced by physical exercise. They commonly involve calf and quadriceps muscles. The pathophysiology of CFS is related to peripheral nerve hyperexcitability, most often located at the motor nerve terminal or intramuscular arborization. methods: A 21-year-old man presented with a progressive syndrome of bronchospasm, cramps and muscle twitches related to physical exercise. Spirography showed bronchial hyperresponsiveness, so he received inhaled corticosteroids and beta2-agonists that improved respiratory symptoms. Electrodiagnostic studies were consistent with CFS. Gabapentin was then introduced. RESULTS: Both respiratory and muscle symptoms improved. A new spirogram after all inhaled medication had been discontinued was normal. CONCLUSION: This picture suggests a concomitant involvement of the peripheral motor nerves of both skeletal and airway autonomic smooth muscle, a presentation not previously reported in CFS. ( info) |
| Two cases of cough-variant asthma are presented, one in an adult and one in a child. We discuss the diagnosis, treatment, and course of this common, yet often unrecognized entity. The keys to diagnosis are a typical history, clinical suspicion, and subsequent response to bronchodilator therapy. Treatment of cough-variant asthma is no different from that of classic asthma. ( info) |
| We present a case of exercise-induced anaphylaxis with improvement following the removal of dental amalgam. Although her symptoms were unresponsive to various kinds of therapy until removal of the amalgam, her symptoms related to exercise improved remarkably after the removal. The increase in plasma histamine levels for exercise provocation test also improved. This suggests that sensitivity to metals might cause exercise-induced asthma in some patients. ( info) |
8/18. Aortic arch anomaly presenting as exercise-induced asthma. We present the case of a young woman with a right aortic arch who first became symptomatic when she began a vigorous exercise program. Her symptoms were very suggestive of exercise-induced bronchospasm. Her flow-volume curves, however, showed evidence of variable intrathoracic large airways obstruction. A magnetic resonance imaging scan confirmed the presence of severe tracheal narrowing caused by her right aortic arch. ( info) |
9/18. exercise-induced "asthma" as a presentation of bronchial carcinoid. exercise-induced wheezing developed in a previously healthy 14-year-old boy. Chest radiographs revealed hyperlucency of the left lung. Bronchial tomography and bronchoscopy revealed a mass in the left mainstem bronchus, identified as a carcinoid tumor after surgical excision. The patient is now asymptomatic. exercise-induced wheezing as the sole manifestation of this tumor has not been previously reported. ( info) |
10/18. Bronchial asthma in servicemen--a personal view. This paper is a review of 59 serving male officers and soldiers with bronchial asthma who attended the Chest Clinic at the Cambridge Military Hospital during a defined period of time and who had been under the care of the author for periods of up to six years. The patterns of presentation, management, progress and outcome are described. exercise induced asthma is seen as the biggest problem for servicemen often with otherwise mild asthma, and there is evidence that potential recruits are still not being adequately assessed. In younger men, exercise associated disability is an early symptom, but older individuals tend to divide into one group with early exercise related problems and another who remain able to exercise at least for a time. Response to prophylactic therapy is good, but it is often difficult to eliminate exercise induced wheeze in military training and relapse is common when prophylaxis is withdrawn. The effect of this on medical category is described and some of the implications are discussed. ( info) |