Respiratory disorders in high-performance athletes: PVFM
Not being able to breathe is frightening, alarming and can trigger panic in the person experiencing it and those around him/her. This is particularly true for those sportsmen who during an intense effort are obliged to abruptly stop their physical activity to try to grasp for air, then living in fear that it can happen again any day.
The Paradoxical Vocal Fold Motion (PVFM) is a temporary total inability to breathe characterised by the closure of vocal folds due to the spasm of laryngeal muscles. It is followed by acute inspiratory dyspnea, that is, difficulty getting a breath in: athletes particularly need to breathe in, therefore to spread their vocal folds.
Often mistaken for asthma or exercise-induced bronchospasms, PVFM has long been considered a psychological disorder and there was no distinction between breathing difficulties and temporary inability to breathe. Now it is possible to make an appropriate differential diagnosis in order to treat it and avoid new crises.
The triggering factors can be classified in three categories:
- Psychological: when the patient makes a bigger effort than usual during competitive sports, especially men or under significant stress due to competition.
Allergic: Laryngeal hypersensitivity of allergic origin that can be associated with asthma.
Irritation: When gastroesophageal reflux (GERD) damages vocal cords
The average time from the first symptoms to diagnosis is about four years. This can be very frustrating for athletes as they try to continue their sport when their symptoms continue to worsen.
This acute dyspnea is different from the need to stop and catch your breath when practicing sport. Unlike this common situation, the athlete has the impression that the airways are blocked, not allowing him/her to breathe in. Acute dyspnea typically disappears quickly when the athlete stops the physical activity that triggered the problem.
PVFM can occur with any sport, such as running, basketball, swimming or dance.
In severe cases, the athletes with PVFM may be brought to the emergency room for further evaluation, due to the importance of their breathing disorders. Respiratory functional examinations will have normal results when PVFM is the cause. Therefore, it will be necessary to make a more comprehensive test with the help of a multidisciplinary staff: an ENT physician, who specialises in the evaluation of voice, upper airway and upper respiratory tract disorders, a speech-language pathologist, who specialises in vocal re-education, and a pulmonologist, who will treat asthma and exercise-induced bronchospasms, which may occur in conjunction with PVFM.
The speech-language pathologist will provide technical and behavioural therapy, by teaching breathing techniques, to relax the chest and the neck and to re-educate the laryngeal functions, to allow the patient to control the opening and closure of his vocal folds. These exercises are incorporated with physical movement that is adapted to the patient’s sport.
An oesophageal fiberscope and above all a pH-meter will diagnose GERD, which must then be treated.