What Is a Pulmonary Stress Test?

At least in the ENT world, a pulmonary stress test is a very useful test when evaluating a patient with symptoms of shortness of breath, stridor, and/or wheezing that occurs only when exercising. The most common reason for an ENT evaluation in these patients is to determine whether paradoxical vocal cord motion is occurring or some other pathology such as tracheomalacia or laryngomalacia. Usually, the patient has already undergone extensive pulmonary testing for asthma and allergies with everything being normal. Even use of inhalers has not been found to be helpful.

The most difficult part of the evaluation in these patients is to perform the exam WHEN the patient is actually having symptoms (ie, during exercise). Doing an evaluation when without symptoms usually results in a normal exam (not surprisingly).

That's where the pulmonary stress test comes in. The philosophy behind this test is to allow for an evaluation when the patient is actually having symptoms.

Under a controlled situation, the patient is asked to start exercising on a treadmill or bicycle. Heart rate, EKG, respiratory rate, etc are all monitored during exercise. When symptoms of stridor or shortness of breath occur, the ENT performs a fiberoptic laryngoscopy exam on the spot to evaluate vocal cord motion and laryngeal structure. In some cases, even awake bronchoscopy may be performed to look for tracheomalacia.

Our office in cooperation with Fauquier Hospital offers this service.

Image taken from wikipedia.

New Video Example of "Non-Organic Stridor"

A new video example of a young patient with audible wheezing on fast breathing due to "non-organic stridor" has been posted. Patients with non-organic stridor are often erroneously diagnosed with vocal cord dysfunction (VCD) or exercise-induced asthma. Indeed, the only thing wrong with patients with non-organic stridor is the fact they produce a wheezy noise while breathing which can be simply controlled by breathing in through the nose or slowing down their breathing rate. No medications or really any other treatment is required.

The typical patient with non-organic stridor is a young female athlete whose symptoms occur during heavy exercise. Usually, the noisy breathing is described as wheezing or stridor and most prominent on inhalation though could occur on exhalation.