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首页> 外文期刊>Seminars in Respiratory and Critical Care Medicine >Asthma: Vocal cord dysfunction (VCD) and other dysfunctional breathing disorders
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Asthma: Vocal cord dysfunction (VCD) and other dysfunctional breathing disorders

机译：哮喘：声带功能障碍（VCD）和其他呼吸功能障碍

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Vocal cord dysfunction (VCD) and dysfunctional breathing (DB) disorders may mimic or coexist with asthma, leading to overtreatment with corticosteroids with consequent morbidity. Iatrogenic complications can be averted by early and correct diagnosis. VCD, also termed paradoxical vocal fold motion disorder (PVFMD), is characterized by intermittent paradoxical adduction of the vocal cords, mainly during inspiration, leading to airflow obstruction and dyspnea. Patients with VCD may have repetitive emergency room visits due to acute dyspnea (mimicking exacerbations of asthma). In the seminal descriptions of VCD, young women (often with psychiatric issues) predominated; however, other groups at increased risk for developing VCD include elite athletes, military recruits, and individuals exposed to irritants (inhaled or aspirated). Chronic postnasal drip, laryngopharyngeal reflux (LPR), and gastroesophageal reflux (GER) may lead to laryngeal hyperresponsiveness. The diagnosis of VCD may be difficult because physical exam and spirometry may be normal between episodes. During symptomatic episodes, spirometry typically reveals variable extrathoracic airway obstruction (truncated inspiratory flow volume loop). The gold standard for identifying VCD is flexible fiberoptic rhinolaryngoscopy. Management of VCD includes identification and treatment of underlying disorders (eg, chronic postnasal drip, LPR, GER, anxiety, depression) and a multidisciplinary approach (including highly trained speech therapists). Speech therapy and biofeedback play a critical role in teaching techniques to override various dysfunctional breathing habits. When postnasal drip, LPR, or GER coexist, these disorders should be aggressively treated. With successful therapy, corticosteroids can often be discontinued. During severe, acute episodes of VCD, therapeutic strategies include heliox (80% helium/20% oxygen), topical lidocaine, anxiolytics, and superior laryngeal blocks with Clostridium botulinum toxin. DB is a poorly understood disorder with features that overlap with VCD and asthma. The dysfunctional pattern may reflect abnormalities in the rate or depth of breathing or in breathing mechanics that may involve the nasal passages, oropharynx, larynx, or chest wall muscles. Not unlike VCD, patients with DB are often diagnosed with asthma, and their symptoms do not improve on asthma medicines. There is no consensus regarding diagnostic criteria or appropriate testing for DB. The pathophysiology of DB is poorly understood, but psychological or physiological stress may precipitate episodes in some patients. Treatment requires a multidisciplinary approach (including speech therapy and psychological support). Prognosis is usually good.
机译：声带功能障碍（VCD）和呼吸功能障碍（DB）障碍可能与哮喘相似或并存，导致皮质类固醇激素过度治疗并因此而发病。早期和正确的诊断可以避免医源性并发症。 VCD，也称为自相矛盾的声带运动障碍（PVFMD），其特征在于声带的间歇性自相矛盾的内收，主要是在吸气过程中，导致气流阻塞和呼吸困难。 VCD患者可能会因急性呼吸困难（模仿哮喘发作）而反复去急诊室就诊。在VCD的开创性描述中，年轻女性（通常患有精神疾病）占主导地位。但是，其他发展成VCD的风险较高的人群包括精英运动员，新兵和暴露于刺激物（吸入或吸入）的个人。慢性鼻后滴漏，喉咽反流（LPR）和胃食管反流（GER）可能导致喉头反应过度。 VCD的诊断可能很困难，因为两次发作之间的体格检查和肺活量测定可能是正常的。在症状性发作期间，肺活量测定通常会显示出可变的胸腔气道阻塞（截断的吸气流量环）。识别VCD的金标准是柔性纤维鼻喉镜。 VCD的管理包括识别和治疗潜在的疾病（例如，慢性滴鼻液，LPR，GER，焦虑症，抑郁症）和多学科方法（包括训练有素的言语治疗师）。语音治疗和生物反馈在教学技术中起着至关重要的作用，以克服各种呼吸功能障碍的习惯。当滴鼻液，LPR或GER共存时，应积极治疗这些疾病。通过成功的治疗，皮质类固醇通常可以停药。在VCD的严重急性发作期间，治疗策略包括氦氧混合气（80％氦气/ 20％氧气），局部利多卡因，抗焦虑药和肉毒梭菌毒素引起的喉上阻滞。 DB是一种鲜为人知的疾病，其特征与VCD和哮喘重叠。功能失调的模式可能反映呼吸速率或深度的异常，或反映可能涉及鼻腔通道，口咽，喉或胸壁肌肉的呼吸机制异常。与VCD一样，DB患者通常被诊断出患有哮喘，并且使用哮喘药物后症状并未改善。关于诊断标准或针对DB的适当测试尚无共识。 DB的病理生理学知之甚少，但心理或生理压力可能会使某些患者发作。治疗需要多学科的方法（包括言语治疗和心理支持）。预后通常良好。

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