Sudden breathing problem while participating in sport

[sanik]

My friend and I are fencers. Fencing is a very aerobic sport and, of course, it requires breathing correctly. Also, sometimes the hit of the opponent can be painful. The other day we were practicing fencing and suddenly my friend started suffocating. By the sound it looked like his air passages closed, so my friend could not inhale the air. I told him to hold his breath, and to slowly inhale through the nose, and then slowly exhale through the mouth. It helped, in five minutes he was ok.

Some facts:
1. It never happened before. Although my friend claims he had asthma in the childhood. It seems too sudden for an asthma attack.
2. The whole thing happend very fast: we were fencing, and suddenly my friend stopped, and I heard he is struggling to inhale the air.
3. Right before the breathing accident, I have not attempted to make any hits. Hence, I don't think there was pain to cause the breathing problem. However, I can't rule out this possibility.
4. The whole thing ended pretty fast too. In 5 minutes or so my friend was breathing without a problem. And in about 20 minutes he was breathing as usually.
5. While watching my friend fencing with other people, I noticed that his breathing is not good: if the fencing fight takes longer than usual, then I could hear how heavy his breath is.

My questions are: what possibly can it be? what can possibly cause it? what can be done?
Thank you very much.

[National Jewish]

The onset is too sudden for asthma.  What you have described is more in keeping with vocal cord dysfunction (VCD).  VCD is a condition that can mimic asthma.  However, VCD is not helped by asthma medicines.  While inhaling the vocal cords should open to let air into the lungs.  With VCD the vocal cords close together during inhalation.  This makes it difficult for air to get into the lungs.  A lot of the same things that trigger asthma can trigger VCD including respiratory infections, fumes, odors, reflux, cigarette smoke, singing, emotional upset, postnasal drip, and exercise.  Sometimes the trigger is not known.

Testing for VCD needs to be done while having symptoms.  Spirometry may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while he is inhaling.  A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how your friend’s vocal cords open and close.

VCD is treated by a speech therapist who will instruct your friend in the open throat breathing technique.  Counseling can help him to identify and deal positively with chronic stress, which may be an underlying factor in VCD.  Please read our vocal cord dysfunction information at http://www.nationaljewish.org/disease-info/diseases/vcd/index.aspx to learn more.  It is important for your friend to be evaluated by a doctor to determine his problem.  Only then can he be treated appropriately, since asthma medicines do not help VCD and the open throat breathing technique does not help asthma.

It is possible to have vocal cord dysfunction (VCD) with or without asthma.  It will take testing to answer your questions and to determine your friend’s problem.  If he has both, it is important that he learn to tell whether it is the VCD or the asthma causing the attack.  Only then will he be able to use the treatment that will help stop the attack.

Once you have asthma, you always have asthma.  It is possible to go through a period of time without symptoms, but it is also possible that the symptoms may return at any point in time.  The symptoms of asthma are chest tightness, coughing, shortness of breath, and wheezing.  Each person with asthma could have only one of these symptoms or a combination of any of these symptoms, including all four of them.  There is no cure for asthma at this time, but it can be controlled with medicine.  With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  A rescue inhaler relaxes the smooth muscle tightness around the airways quickly, but does not do anything for the inflammation.  When used routinely inhaled steroids decrease and prevent inflammation.  If this inflammation is not controlled, it increases the sensitivity of the airways to a variety of things that make asthma worse.  These asthma triggers vary from person to person.  For some people exercise causes more asthma symptoms, but for other people exercise does not cause asthma symptoms at all.  Please read our exercise-induced asthma information at http://www.nationaljewish.org/disease-info/diseases/asthma/living/healthy/exercise.aspx to learn more.  If your friend has not been having asthma symptoms, it is possible that he has not been taking asthma medicines.  If his asthma symptoms are returning, it is important that he start taking asthma medicines.

Generally testing for asthma starts with a simple breathing test called spirometry.  This test provides detailed information about how the lungs are working.  It will show if there is obstruction in the airways.  To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol.  This measures how much the bronchodilator helps the lungs by reversing the problem.  When there is a 20% increase the test is positive for asthma.  However it is possible for this test to be normal when a person with asthma is not having breathing difficulty.  A chest x-ray is done to be sure that there isn’t any other problem that would need to be treated differently.

There is a complex asthma test that is the gold standard for diagnosing asthma.  This is called a methacholine challenge.  Your friend will blow into a spirometer before and after each increasing dose of an inhaled medicine.  This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine.

[myproblem]

With asthma, exhaling is usually the harder part, although it still causes breathlessness. You need to encourage your friend to go to the Dr. and get a set of pulmonary function tests done. This is painless, and covered by insurance. If it is asthma, he should get treatment, but what you're describing sounds like something else to me. Whatever it is, it is best to know what he's up against so he can feel better.

[starion]

The most likely things that your friend MIGHT have are vocal cord dysfunction or perhaps exercise-induced asthma or even hyperventilation.  A good doctor who is familiar with these  conditions can evaluate your friend for these conditions as well as anything else that might be causing him/her to have trouble breathing.  It would be good for your friend to get a thorough evaluation as soon as possible--breathing difficulties should be addressed rather than ignored.

Here's some info about Vocal Cord Dysfunction
http://www.njc.org/disease-info/diseases/vcd/index.aspx

Here's some about exercise-induced asthma
http://www.nationaljewish.org/disease-info/diseases/asthma/living/healthy/exercise.aspx

Here's a brief article about hyperventilation
http://www.mothernature.com/Library/Bookshelf/Books/19/124.cfm

Good luck!  Your friend is lucky you are so concerned & supportive!
Starion