Breathing Difficulty During Exercise in a Female High School Basketball Player

Blair DF, Blair KK, Schnibbe HD, Freed SD: Wenatchee High School, Wenatchee, Washington

Background: This is a 16 year-old, sophomore, female basketball player with a two-year history of breathing difficulties that started during her eighth-grade year. She went from being a top athlete in cross country and basketball during her seventh grade year to having difficulty “getting air in” while running during practices and games the following year. Two physicians diagnosed her with exercised induced asthma (EIA). She was using an albuterol inhaler as part of her treatment. Later, she also was prescribed a leukotriene blocker, Singulair. The albuterol inhaler did not alleviate her symptoms; in fact, at times it made her symptoms worse. Her performance in practices and games continued to suffer. Her symptoms were so severe that she needed to use a nebulizer at night on occasion. Differential diagnosis: Laryngospasm, Laryngomalacia, Neoplasms, Spastic dysphonia and other neuropathies, Bulbar Palsy, Vocal cord dysfunction, Exercise-induced asthma, Ludwig’s Angina, angioedema, Subglottic stenosis. Treatment: The athlete’s family physician attended a basketball practice that included a vigorous conditioning session. Upon thoracic auscultation, her stidor was audible on inspiration. A subsequent spirometry test indicated the FEV1 (forced expiratory volume in one second) was normal. However, there was an apparent blunting of the flow-volume loop on the inspiratory portion of the test, indicating difficulty during inspiration. Following these tests, she was diagnosed with vocal cord dysfunction (VCD). She visited a speech therapist for four sessions of breathing retraining. These sessions helped teach her to breathe under stress, e.g., breathing through the nose and vocal cord relaxation techniques such as keeping the neck slightly extended during exercise. She followed a regular regime of vocal cord exercises and gradually reduced her symptoms that season. She completed the following two basketball seasons of her high school career symptom free. Uniqueness: Vocal cord dysfunction is often overlooked as a diagnosis for breathing difficulties in the athlete. VCD is also unique in that a high percentage of those with this condition are young females (Powell, 2000- average age 14.5, 82% female; Landwehr, 1996- average age 14.7, 86% female). Conclusions: Athletic trainers and physicians need to be aware of vocal cord dysfunction as a possible diagnosis, especially in those cases where traditional therapies for EIA are not successful. Many times athletes with breathing difficulties are “automatically” diagnosed with EIA. The key difference between EIA and VCD is that athletes with VCD have difficulty inspiring air, while those with EIA present with problems in expiring air. The fact should not be overlooked that VCD and EIA may also be found concomitantly in the athlete. Since athletic trainers are “front line” practitioners, distinguishing breathing disorders and making appropriate referrals is of vital importance.

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