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Case Reports
. 2017 Jun 28:5:150.
doi: 10.3389/fped.2017.00150. eCollection 2017.

Bronchial or Laryngeal Obstruction Induced by Exercise?

Ayoub Bey  1 , Sophie Botti  1 , Laurianne Coutier-Marie  2 , Claude Bonabel  2   3 , Stéphanie Metche  2 , Silvia Demoulin-Alexikova  2   3 , Cyril Etienne Schweitzer  2   3   4 , François Marchal  2   3 , Laurent Coffinet  1 , Iulia Ioan  2   3
Affiliations
Case Reports

Bronchial or Laryngeal Obstruction Induced by Exercise?

Ayoub Bey et al. Front Pediatr. .

Abstract

A child suspected of exercise-induced laryngeal obstruction and asthma is examined by laryngoscopy and respiratory resistance (Rrs) after exercise challenge. Immediately at exercise cessation, the visualized adduction of the larynx in inspiration is reflected in a paroxystic increase in Rrs. While normal breathing has apparently resumed later on during recovery from exercise, the pattern of Rrs in inspiration is observed to reoccur following a deep breath or swallowing. The procedure may thus help diagnosing the site of exercise-induced obstruction when laryngoscopy is not available and identify re-inducers of laryngeal dysfunction.

Keywords: asthma; dyspnea on exertion; forced oscillations; respiratory resistance; spirometry.

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Figures

Figure 1
Figure 1
Pictures from the videolaryngoscopy taken immediately after exercise showing the vocal cord adduction in inspiration (left) and abduction in expiration (right).
Figure 2
Figure 2
Baseline recording of tidal flow (V′, dotted line)—inspiration upward—and respiratory resistance (Rrs, bold line). The tracings are superimposed to emphasize the normal Rrs variation that follows the absolute value of flow in both inspiration and expiration.
Figure 3
Figure 3
Recording of flow (V′, dotted line) and respiratory resistance (Rrs, bold line) 5 min after exercise shows first a normal Rrs pattern for three breaths. The transient interruption of expiratory flow at fourth breath (arrow) is followed by a dramatic increase in Rrs during the following inspiration that also shows flow limitation. The pattern is continued for the next inspirations. Note transient interruptions of Rrs trace due to the filtering procedure.
Figure 4
Figure 4
Recording of flow (V′, dotted line), tidal volume (V, light), and respiratory resistance (Rrs, bold line) 15 min after exercise. The normal Rrs pattern is dramatically altered after the deep breath. A large increase in Rrs in inspiration occurs during the next few breaths. Also note inspiratory flow limitation on first breath after deep inhalation.
See this image and copyright information in PMC

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