Best Practice Case Studies-The Dyspneic Athlete

Pdf Summary

The article "Field Management of Sports Injuries" by David Krey and Thomas Best, published online in 2014, discusses common breathing issues in athletes, particularly focusing on exercise-induced bronchoconstriction (EIB) and paradoxic vocal fold movement disorder (PVFMD), often referred to as vocal cord dysfunction (VCD). The misdiagnosis of PVFMD as EIB can lead to unnecessary treatments, which highlights the importance of accurate diagnosis and appropriate management to avoid unnecessary healthcare costs.<br /><br />EIB is more prevalent among athletes than the general population, particularly in cold weather sports and those involving high ventilatory demands, due to environmental triggers like chlorine, chemicals in ice rinks, etc. The condition involves acute bronchoconstriction provoked by exercise, with symptoms including cough, wheezing, chest tightness, and fatigue. Diagnosing EIB accurately is challenging as symptoms overlap with other conditions, necessitating objective testing such as spirometry and bronchoprovocation tests. Treatment generally involves short-acting beta agonists, and in some cases, inhaled corticosteroids or leukotriene modifiers.<br /><br />PVFMD, often confused with asthma, is characterized by intermittent breathing difficulties due to abnormal vocal cord movements during exercise. It is underdiagnosed, leading to increased healthcare costs. Treatment prioritizes behavioral therapy with speech-language pathologists, supported by addressing comorbid conditions such as anxiety and reflux.<br /><br />The authors argue for a comprehensive differential diagnosis when athletes present with dyspnea, considering other causes such as cardiac issues, pulmonary embolus, and pneumomediastinum. Accurate diagnosis begins with a thorough history and physical exam and may require multidisciplinary management. The review emphasizes understanding medications and testing regulations related to respiratory issues in athletes.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 33

Topic Lung

Keywords

3rd Edition, CASE 33

3rd Edition

Lung

exercise-induced bronchoconstriction

paradoxic vocal fold movement disorder

vocal cord dysfunction

athletes

misdiagnosis

breathing issues

diagnosis

treatment

spirometry

behavioral therapy