RESUMO
The present case study reports the first case of a 38-year-old hairdresser with irritant-associated vocal cord dysfunction (VCD) due to alkaline persulfate, who was referred on suspicion of occupational asthma. Several tests were performed, including specific inhalation challenge and upper airway endoscopy. During the specific inhalation challenge to alkaline persulfate, the patient experienced dysphonia and a non-significant decrease in forced expiratory volume in 1 second on spirometry. Upper airway endoscopy was then performed and revealed VCD. A specific inhalation challenge test is therefore essential in cases of VCD to exclude possible concomitant occupational asthma.
Assuntos
Indústria da Beleza , Disfonia/induzido quimicamente , Descolorantes de Cabelo/efeitos adversos , Irritantes/efeitos adversos , Doenças Profissionais/induzido quimicamente , Prega Vocal/efeitos dos fármacos , Adulto , Asma/diagnóstico , Testes de Provocação Brônquica , Diagnóstico Diferencial , Disfonia/diagnóstico , Disfonia/fisiopatologia , Endoscopia , Feminino , Volume Expiratório Forçado , Humanos , Exposição por Inalação , Doenças Profissionais/diagnóstico , Doenças Profissionais/fisiopatologia , Exposição Ocupacional , Valor Preditivo dos Testes , Espirometria , Prega Vocal/fisiopatologiaRESUMO
The aim of the study was to determine whether the bronchomotor effect of a deep inhalation (DI) may be detected during tidal breathing in asthmatic children with spontaneous airway obstruction (AO). Two groups of children aged 5-15 yrs were studied. AO was mild in group 1 (n=12, forced expiratory volume in one second (FEV1) > or = 75% predicted) and moderate-to-severe in group 2 (n=9, FEV1 > or = 70% pred). The forced oscillation technique at 12 Hz using a head generator allowed the determination of respiratory resistance in inspiration (Rrsi) and expiration (Rrse) before and after DI, at baseline and after salbutamol. At baseline, Rrsi but not Rrse was found to decrease significantly after DI in group 1 but not in group 2. The change induced by DI was significantly different in group 1 (-1.5+/-0.5 hPa x s x L(-1)) compared to group 2 (0.5+/-0.5 hPa x s x L(-1)) and exhibited significant negative correlation to FEV1 % pred. After salbutamol, DI had no effect. In conclusion, asthmatic children show a bronchomotor response to deep inhalation that depends on the degree of airway obstruction. The effect is more readily demonstrated in inspiration than in expiration.