TY - JOUR
T1 - Extrathoracic Obstruction and Hypoxemia Occurring During Exercise in a Competitive Female Cyclist
AU - Haverkamp, Hans
AU - Miller, Jordan
AU - Rodman, Joshua
AU - Romer, Lee
AU - Pegelow, David
AU - Santana, Marcus
AU - Dempsey, Jerome
N1 - Funding Information:
This research was supported by the National Heart, Lung, and Blood Institute and by a grant from the Department of Veterans Affairs/Department of Defense.
PY - 2003/10
Y1 - 2003/10
N2 - A 22-year-old competitive female cyclist complained of cough, chest tightness, and wheeze during high-intensity exercise that had previously been diagnosed as exercise-induced bronchospasm (EIB). A loud stridor, a sensation of her "throat closing," and severe dyspnea developed during maximal cycling exercise with concomitant reductions in both inspiratory and expiratory flow rates. A decrease of 25 L/min (26%) in minute ventilation and arterial hypoxemia (Pao2 decrease, 93 to 76.5 mm Hg) resulted from this obstruction. Spontaneous tidal flow-volume loops (FVLs) during exercise exhibited a sawtooth pattern during inspiration, and substantial drops in flow rates after the stridor developed. However, maximal FVLs were unchanged from baseline following exercise, indicating that the obstruction was not EIB. We suggest that the continuous measurement of spontaneous breath-by-breath tidal FVLs may be a useful diagnostic tool for the identification of exercise-induced extrathoracic obstruction. Additionally, extrathoracic obstruction should be considered as an uncommon but potential cause of inadequate ventilation and arterial hypoxemia during exercise.
AB - A 22-year-old competitive female cyclist complained of cough, chest tightness, and wheeze during high-intensity exercise that had previously been diagnosed as exercise-induced bronchospasm (EIB). A loud stridor, a sensation of her "throat closing," and severe dyspnea developed during maximal cycling exercise with concomitant reductions in both inspiratory and expiratory flow rates. A decrease of 25 L/min (26%) in minute ventilation and arterial hypoxemia (Pao2 decrease, 93 to 76.5 mm Hg) resulted from this obstruction. Spontaneous tidal flow-volume loops (FVLs) during exercise exhibited a sawtooth pattern during inspiration, and substantial drops in flow rates after the stridor developed. However, maximal FVLs were unchanged from baseline following exercise, indicating that the obstruction was not EIB. We suggest that the continuous measurement of spontaneous breath-by-breath tidal FVLs may be a useful diagnostic tool for the identification of exercise-induced extrathoracic obstruction. Additionally, extrathoracic obstruction should be considered as an uncommon but potential cause of inadequate ventilation and arterial hypoxemia during exercise.
KW - Exercise-induced arterial hypoxemia
KW - Exercise-induced bronchospasm
KW - Stridor
KW - Upper airway dysfunction
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U2 - 10.1378/chest.124.4.1602
DO - 10.1378/chest.124.4.1602
M3 - Article
C2 - 14555597
AN - SCOPUS:0142074233
SN - 0012-3692
VL - 124
SP - 1602
EP - 1605
JO - Chest
JF - Chest
IS - 4
ER -