ABSTRACT
We report a case of severe asthma initially considered as cortico-resistant. Clinical analysis of dyspneic attacks demonstrated they were atypical, sometimes associated with dysphonia and syncopes. Severity of clinical presentation was discordant with lung function tests. The diagnosis of vocal cord dysfunction was confirmed by ENT specialized examination. It showed paradoxal inspiratory adduction of the vocal cords triggered by exercise. Treatment remained however difficult, based on speech therapy, relaxation and psychotherapy. This observation underlines the influence of searching a vocal cord dysfunction in cortico-dependent asthma, especially if clinical presentation is atypical. Treatment of this condition may allow to decrease steroid treatment in such patients.
Subject(s)
Asthma/diagnosis , Laryngeal Diseases/diagnosis , Vocal Cords/physiopathology , Adrenal Cortex Hormones/therapeutic use , Adult , Asthma/drug therapy , Bronchodilator Agents/therapeutic use , Diagnosis, Differential , Drug Resistance , Dyspnea/diagnosis , Female , Humans , Inhalation/physiology , Laryngeal Diseases/therapy , Psychotherapy , Relaxation Therapy , Speech Therapy , Status Asthmaticus/diagnosis , Status Asthmaticus/drug therapy , Syncope/diagnosis , Voice Disorders/diagnosisABSTRACT
Bromocriptine, a derivate of ergot of rye, is employed in high doses for the treatment of Parkinson's disease, and may induct pleuropulmonary affections. We report the case of a 75-years-old patient, on bromocriptin for 5 years, who presented a progressive dyspnea, due to a pleural thickening, and moderate interstitial infiltrate, associated with an inflammatory syndrome. The outcome was favorable with 3 months of bromocriptin cessation. These complications are rarely described, probably underestimated, and justify a respiratory follow-up for these patients, who are difficult to stabilize in their neurologic treatment.
