Zusammenfassung
Funktionelle intermittierende Atemstörungen, die durch paradoxe Schlussbewegungen der Stimmbänder hervorgerufen werden, spielen unter dem Begriff Vocal Cord Dysfunction (VCD) in den letzten Jahren eine zunehmend wichtigere Rolle in der Differenzialdiagnose nicht adäquat behandelbarer Asthmaverläufe. Der Anfallscharakter der Atemnot lässt zunächst an ein Asthma bronchiale denken und führt in der Regel zur Einleitung einer entsprechenden medikamentösen Behandlung. In Ermangelung ausreichender Therapieeffekte kann es zu grotesk eskalierender Medikation unter dauerhaftem Einschluss hochdosierter Steroide mit entsprechendem Nebenwirkungspotenzial kommen. Die VCD entzieht sich aufgrund der meist extrem kurzen Symptomdauer von 1 - 2 Minuten dem üblichen diagnostischen Nachweis. Somit ist das klinische Bild einerseits von lebensbedrohlich erlebter Atemnot bei unauffälliger Diagnostik, andererseits von frustranen Therapieansätzen gekennzeichnet. Dies führt zu teils ausgeprägten, destabilisierenden Angst- und Panikstörungen. Infolge dessen imponieren solche Krankheitsverläufe klinisch als therapierefraktär. Die exakte Kenntnis des Krankheitsbilds VCD lenkt den Blick des Arztes oft ohne weitere Hilfsmittel bereits zur richtigen Verdachtsdiagnose. Die VCD muss als Herausforderung in der täglichen pneumologischen Arbeit verstanden werden, um durch eine frühzeitige Diagnose Patientenkarrieren mit teils höchst relevanten medizinischen wie auch wirtschaftlichen Folgen zu verhindern. Ziel dieses Beitrags ist es, das aktuelle Verständnis der VCD bzgl. epidemiologischer, pathophysiologischer und klinischer Implikationen zusammen mit diagnostisch/therapeutischen Möglichkeiten darzustellen und zu diskutieren.
Abstract
Vocal Cord Dysfunction (VCD), intermittent dyspnoea attacks caused by episodic paradoxical adduction of the vocal cords, plays an important role in the differential diagnosis of so called intractable or difficult to control bronchial asthma. The clinical symptoms may mimic asthma, resulting in high dose medications that often lead to considerable iatrogenic induced morbidity e. g. high dose systemic corticosteriods. In most cases VCD cannot be demonstrated using common diagnostic methods, due to self-limiting symptoms of less than one to two minutes. A typical VCD-patient presents with seemingly life-threatening dyspnoea with negative diagnostic results for asthma or other standard airway disorders and lack of improvement with standard medications. The frustrating clinical course can induce significant psychiatric disorders such as anxiety and panic attacks in VCD-patients. Increased knowledge of the characteristic clinical symptoms of vocal cord dysfunction can help physicians identify the correct diagnosis even without further testing. VCD should be seen as a challenge to every pulmonologists. Early diagnosis prevents prolonged clinical courses including negative effects due to medication as well as economical consequences. The aim of this paper is to present and to discuss the current understandings of the clinical and pathophysiological aspects of this disease.
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Dr. med. Klaus Kenn
Klinikum Berchtesgadener Land, Abteilung Pneumologie
Malterhöh 1
83471 Schönau am Königssee
eMail: kkenn@schoen-kliniken.de
