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Dyspnea in a college athlete

Case Editor - Judd Flesch

Reviewed By Allergy, Immunology & Inflammation Assembly

Submitted by

Jonathan P. Parsons, M.D.

Assistant Professor of Internal Medicine

The Ohio State University Medical Center

Columbus, Ohio

Submit your comments to the author(s).


An 18 year-old female college student presents to the student health center complaining of cough and chest tightness that occurs frequently with exercise. She is on the varsity field-hockey team and notes she occasionally has trouble keeping up with the other players during practice and games. Her coach has been criticizing her frequently for what he construes as “poor effort.”   Her cough is episodic and is non-productive.  Her dyspnea seems to occur after several minutes of exercise, and she states it feels like she cannot get a deep breath.  She does not notice symptoms at other times of the day when she is not exercising.  She has been particularly stressed emotionally recently as her first final exam period in college is approaching, and her field-hockey team has advanced to the semifinals of the conference tournament.  Her review of symptoms is otherwise unremarkable.

Her past medical history is only significant for a torn knee ligament two years prior to her current presentation.  She has no known history of asthma and does not have problems with perennial allergies.  She takes oral contraceptive pills and nutritional supplements and denies any known drug allergies.  She is a freshman in college and does not smoke.  She admits to alcohol use in moderation and denies any illicit drug use.  Her family medical history is unremarkable; her sister and parents are healthy without significant medical problems including asthma.

Physical Exam

On physical exam, she is a healthy, age-appropriate female in no acute distress. The head and neck exam is benign without stridor. Lung exam reveals normal breath sounds without wheezing. Heart exam reveals a regular rhythm with no murmurs, gallops, or rubs. Abdominal exam is benign. The extremities are without cyanosis, clubbing or edema. The neurologic exam is non-focal.


Spirometry:  FVC of 104% of predicted, FEV1 of 98% of predicted, normal FEV1/FVC ratio, and normal flow-volume loops.

Electrocardiogram:  Normal sinus rhythm, normal intervals, and no ST-segment changes.

Eucapnic voluntary hyperventilation testing:  13% drop in FEV1 compared to baseline documented at 10 minutes post-test.

Question 1

Given the history and objective testing provided, what is the most likely diagnosis in this case?


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