声帯機能不全の若い患者における気管支喘息の症例

[A CASE OF BRONCHIAL ASTHMA IN A YOUNGER PATIENT WITH VOCAL CORD DYSFUNCTION].

• Hirohito Sano
• Teruyuki Satou
• Koji Murakami
• Yutaka Tojo
• Risa Shibuya
• Ayumi Mitsune
• Shun Yamanaka
• Tsutomu Tamada
• Hisatoshi Sugiura
• Masakazu Ichinose

抄録

2歳からの気管支喘息の既往歴を持つ17歳女性の症例を紹介する。彼女は14歳から毎日のように喘息発作を起こしており，定期的な吸入コルチコステロイド吸入に経口コルチコステロイドとオマリズマブを加えても症状の緩和には至らず，当院に紹介された。当院に紹介され、精密検査を受けた。入院時の身体所見は正常であったが、ラウンド時に呼吸困難を訴えていた。前頸部に単音性の喘鳴と喘鳴が聴取されたが、胸部のどの部位にも音は聴取されなかった。喉頭鏡検査で声帯の逆説的な動きが認められ，声帯機能障害（VCD）と診断された．明らかに重篤な喘息症状はVCDを反映していると考えられ，喘息発作の再発もなく気管支喘息の治療はステップダウンした。VCDの病因は不明であったが、VCDは若い女性に多いことから、ストレスや性格的要因が関与していると考えられる。小児喘息は小児期から青年期にかけて改善することが多いが、難治例も指摘されている。難治性の気管支喘息症例では、VCDなどの他疾患の合併症を考慮し、適切な管理を行う必要があります。

We present a case of a 17-year-old woman with a history of bronchial asthma since two years of age. She had daily asthma attacks from the age of fourteen, and the addition of oral corticosteroids and omalizumab to regular inhaled corticosteroid inhalation failed to relieve symptoms. She was referred to our hospital for detailed examination. On admission, physical examination was normal, but she had complained of dyspnea at the round. Monophonic wheezes and stridor were heard over the anterior neck, while no rales were audible over any part of the chest. Laryngoscopy revealed paradoxical movement of the vocal cords, and a diagnosis of vocal cord dysfunction (VCD) was made. The apparent severe asthma symptoms were considered to reflect VCD, and the treatment for bronchial asthma was stepped down without any recurrence of asthma attacks. Although the etiology of the VCD was unknown, VCD is more common in young women, so stress and personality factors are thought to be involved. It has been noted that childhood asthma often improves between childhood and adolescence, but refractory cases have been noted. In intractable bronchial asthma cases, it is necessary to consider the complications of other diseases, such as VCD, and to perform appropriate management.