Allergy Asthma Immunol Res.  2014 May;6(3):267-269. 10.4168/aair.2014.6.3.267.

Laryngeal Spasm Mimicking Asthma and Vitamin D Deficiency

• Masoero M
• Bellocchia M
• Ciuffreda
• Ricciardolo FLM
• Rolla G
• Bucca C

• KMID: 2260691
• DOI: http://doi.org/10.4168/aair.2014.6.3.267

Abstract

We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respiratory clinic for suspect bronchial asthma. Spirometry showed mild decrease in inspiratory flows. Methacholine challenge was negative. Dyspnea was triggered by hyperventilation-induced hypocapnia, which produced marked decrease in airflow rates, particularly in inspiratory flows, consistent with laryngospasm. Nutritional assessment of the patient showed low serum level of calcium and vitamin D, attributable to avoidance of milk and dairy products for lactose intolerance and to insufficient sunlight exposure. After calcium and vitamin D supplementation episodic laryngospasm disappeared and hypocapnic hyperventilation test induced very mild change in airflow rates. Calcium and vitamin D deficiency may favour laryngeal spasm mimicking asthma, particularly in subjects with underlying myopathy.

Keyword

Laryngeal spasm; asthma; vitamin D deficiency; calcium deficiency

MeSH Terms

Airway Obstruction
Asthma*
Calcium
Carnitine
Dairy Products
Dyspnea
Female
Humans
Hyperventilation
Hypocapnia
Lactose Intolerance
Laryngismus*
Methacholine Chloride
Milk
Muscular Diseases
Nutrition Assessment
Spirometry
Sunlight
Transferases
Vitamin D
Vitamin D Deficiency*
Calcium
Carnitine
Methacholine Chloride
Transferases
Vitamin D

Figure

• 

  Figure Flow-volume loop before and after the hyperventilation test. (A) during calcium and vitamin D deficiency, (B) after treatment with calcium and vitamin D for 2 months.

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