Exercise-induced Vocal Cord Dysfunction Presenting as Asthma in Pediatric Patients: Toxicity of Inappropriate Inhaled Corticosteroids and the Role of Exercise Laryngoscopy

Abstract

Chevalier Jackson, M.D., noted, and it is often reiterated, that "not all that wheezes is asthma." This is often the case in pediatric patients in whom there is a broad differential diagnosis for chronic respiratory symptoms. Children and adolescents with chronic respiratory symptoms require thoughtful and complete evaluation to avoid misdiagnosis with the potential for harm due to inappropriate medical therapy. This is particularly true of patients with vocal cord dysfunction, which is a common mimic of asthma. In this report, we present the case of an adolescent female athlete with exercise-induced vocal cord dysfunction misdiagnosed as asthma. Significant adrenal suppression resulted due to high doses of inhaled corticosteroids. The diagnosis of exercise-induced vocal cord dysfunction was confirmed by performing a flexible laryngoscopy during a maximal cardiopulmonary exercise test. We review our experience with a technique of combined exercise testing and real-time flexible laryngoscopy in athletes with atypical dyspnea and discuss the potential side effects of inhaled corticosteroids in pediatric patients.