Exercise-induced Paradoxical Vocal Fold Motion Disorder: Clinical Feature Characteristics and Potential Mechanisms

The experimental protocol consists of five stages in total (Stages IV): (1) Screening, (2) Pre-Baseline, (3) Baseline Laryngoscopy Condition, (4) Exercise Laryngoscopy Condition, and (5) Recovery. The following sections describe procedures conducted within each of the five stages

Stage I: Screening

To determine eligibility, all consenting participants will (1) undergo spirometric screening to rule out any indication of pulmonary pathology, (2) report they partake in athletic activity within a competitive environment (self-perceived/reported), and (3) complete the Dyspnea Index (DI). Participants with less than 80% predicted FEV1 on spirometry will be excluded from the study and referred to the pediatric pulmonary clinic at Massachusetts General Hospital (MGH). Anyone who reports they feel their sports-related activities are not competitive will be excluded. Participants in the E-PVFMD group who score less than 10 out of 40 on the DI will be excluded from the study, whereas participants in the at-risk group who score more than 6 out of 40 on the DI will be excluded from the study.

Stage II: PreBaseline

All participants who have passed the screening will rate the worst severity of perceived shortness of breath experienced during the screening period, as well as other symptoms relating to PVFMD (i.e., cough, globus, dysphonia, laryngeal pain/tension), on a 0100mm visual analog scale (VAS). These values will later serve as anchors for subsequent symptom ratings. Rating severity of symptoms prior to laryngoscopy will also prime participants for symptom severity ratings in subsequent conditions, described shortly in detail. Next, blood pressure (SBP) and heart rate (HR) readings will be obtained three times (x3) at 30-second intervals or greater over a 5minute period, using a blood and heart rate monitor. The three readings will then be averaged and used as anchors for SBP and HR readings taken during subsequent study phases. Two self-reported questionnaires will then be administered to all enrolled participants: the Early Adolescent Temperament Questionnaire - Revised-short form (EATQ-R-SF) and the Paffenbarger Physical Activity Questionnaire (PPAQ). Participants will read and complete the two questionnaires on their own, although the PI or parent/guardian may clarify questions or help participants read instructions, especially with younger participants. Last, a respiratory transducer band will be placed on ribs 5-8 to measure respiratory rate (RR) and tidal volumes (TV). These parameters may be used to stratify/bin data, posthoc.