Investigación de enfermedad

IRRITANT VOCAL CORD DYSFUNCTION AND OCCUPATIONAL BRONCHIALASTHMA: DIFFERENTIAL DIAGNOSIS IN A HEALTH CARE WORKER.Texto completo disponibleBy: Tonini, Stefano; Dellabianca, Antonio; Costa, Cristina M.; Lanfranco, Andrea; Scafa, Fabrizio; Candura, Stefano M.. International Journal of Occupational Medicine & Environmental Health, Oct2009, Vol. 22 Issue 4, p401-406, 6p, 1 Black and White Photograph,2 Graphs; DOI: 10.2478/v10001-009-0038-z; (AN 48000902)
Database: Academic Search Complete
*  

C A S E R E P O R T S
International Journal of Occupational Medicine and Environmental Health 2009;22(4):401 – 406
DOI 10.2478/v10001-009-0038-z
IRRITANT VOCAL CORD DYSFUNCTION
AND OCCUPATIONAL BRONCHIAL ASTHMA:
DIFFERENTIAL DIAGNOSIS
IN A HEALTH CARE WORKER
STEFANO TONINI1,2, ANTONIODELLABIANCA1,2, CRISTINA M. COSTA1,2, ANDREA LANFRANCO1,2,
FABRIZIO SCAFA1,2, and STEFANO M. CANDURA1,2
1 University of Pavia, Pavia, Italy
Department of Preventive, Occupational and Community Medicine
2 Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS,
Scientific Institute of Pavia, Pavia, Italy
Division of Occupational Medicine
Abstract
Objectives: Vocal cord dysfunction (VCD) isan uncommon respiratory disease characterized by the paradoxical adduction
of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCD has not been clearly defined
but it is possible to recognize non-psychologic and psychologic causes. The majority of patients are female but, interestingly,
a high incidence of VCD has been documented in health care workers. Amisdiagnosis with asthma leads to hospitalisation,
unnecessary use of systemic steroids with related adverse effects, and sometimes tracheostomy and intubation. In a subset
of VCD patients, the disease can be attributed to occupational or environmental exposure to inhaled irritants. Materials
and Methods: We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing,cough, dyspnoea
related to inhalation of irritating agents (isopropylic alcohol, formaldehyde, peracetic acid). She underwent chest radiography,
pulmonary function assessment both in the presence and in the absence of symptoms, bronchial provocation with
methacholine and bronchodilation test with salbutamol to recognize asthma’s features, allergy evaluation by skin prick tests
and patch testsand video-laryngoscopy. Results: VCD diagnosis was made on the basis of video-laryngoscopy, that visualized
the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes. Conclusions:
This case fulfils the proposed criteria for the diagnosis of irritant VCD (IVCD). This is the first report of VCD onset
following exposure to several irritants:���������������������������������������������������������formaldehyde, glutaraldehyde,�������������������������������� ������������������������������isopropylic alcohol, peracetic acid-hydrogen peroxide
mixture. These substances are used as cleaning and antiseptic agents in healthcare settings and some ones can also
be found in many indoor environments. A correct diagnosis is important both to give the appropriate treatment andfor
medical legal implications.
Key words:
Vocal cord, Asthma, Irritant
Received: September 18, 2009. Accepted: December 3, 2009.
Address reprint request to S. Tonini, Department of Preventive, Occupational and Community Medicine, Occupational Medicine Section I, University of Pavia,
Via Maugeri, 10, 27100 Pavia, Italy (e-mail: stefano.tonini23@libero.it).
INTRODUCTION
Vocal corddysfunction (VCD) syndrome, which is due to
inappropriate movement of vocal cords during inspiration
with resultant airflow limitation [1,2], is an uncommon disorder
of the larynx that may mimic or coexist with bronchial
asthma [3]. Wheezing, dysphonia, choking feeling,
throat tightness, stridor, dyspnoea, suprasternal and neck
muscle retraction, anxiety and cough are typical...