November 25, 2009
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.