「喘鳴」到「呼吸自由」：矛盾性聲帶運動（PVFM）的跨專業照護模式與非藥物行為治療指引

From“Stridor”to“Breathing Freely”: Interprofessional Clinical Management and Behavioral Treatment Guidelines for Paradoxical Vocal Fold Motion (PVFM)

矛盾性聲帶運動（Paradoxical Vocal Fold Motion, PVFM）是一種吸氣期聲帶反常內收所致的上呼吸道功能性阻塞，其臨床表現與氣喘高度相似，常導致誤診與延遲治療，然而兩者在病因、病理機轉及治療策略上截然不同，氣喘屬於下呼吸道慢性發炎與可逆性氣流受限，治療以吸入型支氣管擴張劑與類固醇為主，而PVFM對此類藥物通常無效，若誤診將造成病人長期暴露於不必要的藥物並增加醫療資源耗用。本文綜整PVFM在呼吸系統疾病中的分類定位，說明其不同於典型阻塞型疾病，應視為功能性呼吸障礙的特殊亞型，並比較PVFM與氣喘在流速容積曲線上的差異。PVFM的病理機轉涉及喉部過度敏感、神經肌肉控制異常及心理與自主神經調控等多重因素，臨床表現包括吸氣性呼吸困難、喉嚨緊縮感、吸氣性喘鳴及多種誘發型態。該症狀以行為治療為主要介入方式，並結合跨專業合作，以提升診斷與治療成效。臨床案例顯示，透過耳鼻喉科確診與跨專業團隊介入，病人能有效掌握自我調適技巧，急性發作頻率降低且生活品質顯著改善。建立「何時懷疑、如何判讀、何時轉介、如何介入」的跨專業指引，並將非藥物行為治療納入急性期與穩定期照護，可縮短診斷延遲、降低誤治與再就醫率，進而提升病人預後與整體照護品質。

Paradoxical vocal fold motion (PVFM) is a functional upper-airway obstruction characterized by inappropriate inspiratory adduction of the vocal folds. Its clinical presentation closely mimics asthma and frequently leads to misdiagnosis and treatment delays; however, the two conditions differ fundamentally in etiology, pathophysiology, and management. Asthma is a chronic inflammatory disease of the lower airways with reversible airflow limitation, typically managed with inhaled bronchodilators and corticosteroids, whereas PVFM generally does not respond to these medications. Misdiagnosis therefore exposes patients to unnecessary pharmacotherapy and increases healthcare resource utilization. This article delineates the taxonomic position of PVFM within respiratory disorders, highlighting that it is distinct from classic obstructive diseases and should be regarded as a specific subtype of functional breathing disorder, and contrasts the characteristic features of PVFM and asthma on the flow–volume loop. The pathophysiology of PVFM involves multiple interrelated mechanisms, including laryngeal hypersensitivity, abnormalities in neuromuscular control, and psychologic and autonomic dysregulation. Clinically, patients present with inspiratory dyspnea, throat tightness, inspiratory stridor, and a range of identifiable triggers. Behavioral therapy is the principal intervention, implemented within a multidisciplinary model to enhance diagnostic accuracy and therapeutic outcomes. Clinical cases indicate that otolaryngologic confirmation coupled with interdisciplinary care enables patients to acquire effective self-management strategies, reduces the frequency of acute episodes, and markedly improves quality of life. Establishing cross-disciplinary guidance—specifying when to suspect PVFM, how to interpret findings, when to refer, and how to intervene—and incorporating nonpharmacologic behavioral therapy into both acute and stable-phase care can shorten diagnostic delays, decrease mistreatment and rehospitalization rates, and ultimately improve patient prognosis and overall care quality.