A Case of Functional Upper Airway Obstruction Due to Vocal Cord Dysfunction in Obstructive Pulmonary Disease

폐쇄성 폐질환에 동반된 성대 운동이상에 의한 기능성 상기도폐색 1예

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve ; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.

성대 운동이상에 의한 상기도 폐색은 드문질환으로 저자들은 호흡곤란을 주소로 내원한 61세 여자환자에서 기관지내시경검사와 폐기능검사로 폐쇄성폐질환에 동반된 성대 운동이상에 의한 기능성상기도 폐색증을 확진하고 이완요법(relaxation)과 산소공급으로 증상이 호전되어 퇴원후 외래에서 추적관찰중인 1예를 경험하여 이를 문헌고찰과 함께 보고하는 바이다.