Irritant Vocal Cord Dysfunction in un’infermiera professionale addetta al servizio di endoscopia digestiva: diagnosi differenziale con l’asma professionale [Irritant vocal cord dysfunction mimicking occupational asthma in a nurse of the digestive endoscopy service]

Vocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords, that may mimic bronchial asthma. We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing, cough, dyspnea related to inhalation of irritating agents (hydrogen peroxide, isopropylic alcohol, formaldehyde, peracetic acid, glutaraldehyde) used as cleaning and antiseptic agents. The patient was referred to our institute for suspected occupational asthma. She underwent physical examination, chest radiography, spirometry, bronchial provocation test with methacoline, bronchodilation test with salbutamol, prick tests and patch tests: bronchial asthma was excluded. Video-laryngoscopy visualized the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes, leading to the diagnosis of VCD. The case fulfils the criteria for the diagnosis of irritant VCD, a condition very rarely described in the healthcare setting. A correct differential diagnosis between irritant VCD and occupational asthma is important in relation to prognosis, treatment and medical legal implications.