Spectrum of Dysfunction Breathing: VCD, malacia, etc. – Twitter summary from #ACAAI18 meeting

Dr. Steve Tilles, M.: In Exercise Induced Asthma – consider doing a post-bronchodilator test to rule out baseline reversibility, some competitive athletes can have FEV1% predicted more than 100%!

5-8 minutes of intense exercise can trigger exercise induced bronchospasm, slowly subsides over 60 minutes.

Dr. Monica Shaffer on exercise induced laryngeal obstruction. Laryngeal obstruction doesn’t typically occur until 75% of maximum exercise, which sometimes don’t align with reported symptoms – therefore sometimes a quick laryngoscopy after running the patient up/down the stairs may miss laryngeal obstruction.

Only a minority of exercise induced laryngeal obstruction patients will demonstrate the classic vocal cord diamond shaped “chink”.

If standard speech pathology is not effective, biofeedback by continuous laryngoscopy during exercise can show the patient their own vocal cords during exercise and give insight / work on breathing techniques.

Dr. Karen Drake: the role of reflux in PVCM is likely over-estimated, the patients with a clear history may benefit from acid suppression but many patients with “edema” on laryngoscopy may not have clinically significant reflux.

Consider the social context in exercise induced laryngeal dysfunction – some patients manifest their dislike of competitive sports with these symptoms, but still do it because they don’t want to disappoint their parent/caregiver.

This is a Twitter summary from #ACAAI18 meeting based on tweets by the following allergists: @DrGerryLee

Uncontrolled asthma: “What to do when asthma is not doing well?” (click to enlarge the image).

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