Les dyspnées en effort sportif sont des épiphénomènes apparemment courants. Considérées comme un phénomène normal conjugué à l'effort, elles sont le plus souvent négligées, tant du point de vue du suivi médicosportif, que par les intéressés qui ne sont pas toujours demandeurs. Ces dyspnées peuvent cependant être handicapantes, voire mortelles: l'effort extrême fourni lors des compétitions peut échapper au contrôle propre du sportif. Il est alors littéralement emporté par son effort et l'organisme n'arrive plus à suivre. Ici pourrait se trouver l'une des explications possibles des morts subites sur stade, avec autopsie blanche. Le diagnostic topographique et étiologique de ces dyspnées en effort intense est le plus souvent présomptif. En effet, la symptomatologie — bien que bruyante — est fugace, et ne permet pas les explorations au moment souhaité. L'apport de la vidéofibroscopie avec enregistrement, en «test réaliste à l'acmé de l'effort déclenchant, confronté à l'examen clinique de repos et aux divers examens complémentaires d'exploration, a permis de poser le diagnostic de certitude de dyspnée haute, laryngée ou trachéale. Nous rapportons ici trois cas cliniques de dyspnée en effort sportif, qui ont posé des problèmes diagnostiques. Cette méthodologie nous a permis un diagnostic à l'examen direct, enregistré, lors du déclenchement du phénomène; de réorienter les thérapeutiques non adaptées; de faire reprendre confiance aux patients en leur donnant une explication plausible du leur état, et surtout, de gérer leur reprise sportive ou compétitive, soit en prévenant les sur-efforts trop hâtifs ou trop rapides, soit en interdisant temporairement ou définitivement la compétition. Acute dyspnea in exercise is frequent, but its diagnosis and etio-topography are often difficult, because of no asking for from the athlete, nor the physicians. We have studyed the case of three patients who suffered from acute dyspnea, which affected their sporting performance. After diverse explorations including respiratory tests, cardiovascular tests and allergic tests, these patients were classified as having “exercise-induced asthma” and were treated as such, but without result. Our methodology consists of reproducing the symptoms in registered video-endoscopy with optic fibre, undertaken during testing. This permits us to rectify and give an etiotopographic diagnosis. The first patient, a young racing cyclist, was seen the first time for repeated acute dyspnea during racing, which obliged him to stop. Previous history included frequent breaks in his sporting activity due to numerous traumatisms. Following various tests, he was classified as having “exercise induced asthma”, although treatment did not give any results. The subject was rediagnosed as having laryngeal and tracheal dyskinesia. The second patient, a teenager, suffered from acute dyspnea whilst participating in school sports. All investigations carried out previously did not show any abnormalities. The patient had also had a long period of rest due to illness. Her problems began following this inactivity. She was also classified as having “exercise-induced asthma”, but did not respond to treatment. Following video-endoscopy, we rediagnosed the patient as having stridor and vocal dyskinesia. The third patient was a nineteen year- old woman, racing roller skater, with no previous surgical treatment apart from an operation on her alves. Following the operation, she complained of discomfort with dyspnea and also felt faint. During tests, we observed the appearance of “laryngomalacy during exercise”. Diagnosis permits us to classe the correct therapy and to manage sporting recovery. It must not be forgotten that these dyspnea may be fatal, and their urgen therapy is invasive: intubation, tracheotomy. In addition their screening, diagnosis and prevention are essential: it is important that they be distinguished from exercise-induced asthma, the diagnosis must not be presumptive (thinking of other possible extra-thoracic origins), and registered video-fiberscopy should be used during testing, which is the only method to verify the diagnosis.
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