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A Case of Dyspnea in a College Athlete

Reviewed By Allergy, Immunology & Inflammation Assembly

Submitted by

Lana Alghothani, MD

Clinical Instructor and Pulmonary/Critical Care Fellow

Department of Internal Medicine

The Ohio State University Wexner Medical Center

Columbus, Ohio

Jonathan P. Parsons, MD

Professor of Internal Medicine

Department of Internal Medicine

The Ohio State University Wexner Medical Center

Columbus, Ohio

Submit your comments to the author(s).


A 21 year old male presents with chest tightness and shortness of breath with exercise.  He is a college track athlete. His symptoms have been ongoing for several years and occur frequently after strenuous exercise sessions.  Specifically, his dyspnea occurs after several minutes of exercise and is associated with wheezing and a non-productive cough.  His review of systems is otherwise negative.  He has not noticed these symptoms outside of exercise.  He is concerned that his symptoms are negatively impacting his athletic performance.

He has no other significant past medical history.  He denies a history of known asthma or perennial allergies.  His family history is unremarkable.  He takes a daily multivitamin and denies any known drug allergies.  He is currently a junior in college and does not smoke cigarettes, though he mentions infrequent marijuana and moderate alcohol use.

Physical Exam

On physical exam, he is a healthy male in no acute distress. His 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. No cyanosis, clubbing or edema of the extremities is noted. A neurologic exam is non-focal.


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

Chest Xray: unremarkable.

Spirometry:  FVC is 4.77L or 97% of predicted, FEV1 is 3.86L or 92% of predicted, normal FEV1/FVC ratio, and normal flow-volume loops.

Eucapnic voluntary hyperventilation testing: maximal decrease of 23% in FEV1 compared to baseline documented at 5 minutes of exercise.

Question 1

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


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