mystery of yawning
Le bâillement, du réflexe à la pathologie
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La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
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21 juillet 2012
Yawning associated with anterior chest pain
in a patient with asthma
 
Fumihiro Mitsunobu, Kozo Ashida, Yasuhiro Hosaki, Hirofumi Tsugeno, Makoto Okamoto, Norikazu Nishida, Takuya Nagata, Shingo Takata and Yoshiro Tanizaki
 
Annual reports of Misasa Medical Center
Okayama University Medical School
01/02/2003

Chat-logomini

 
Abstract
 
We present a case of a patient with asthma who developed yawning associated with anterior chest pain. She was admitted due to severe anterior chest pain, wheezing and dyspnea. Although the frequency of the symptoms decreased, she began to experience frequent episodes of yawning at night accompanied by tears. While she experienced yawning, although PEF (peak expiratory flow) decreased, no asthmatic symptoms, such as wheezing or dyspnea were observed. The yawning was improved markedly by bronchodilators and a leukotriene receptor antagonist, and moderately improved by corticosteroids. We speculated that yawning is a clinical manifestation of asthma that responds to treatment.
 
Case Report
 
 
A 64-year-old woman was admitted to our hospital in February 1993, due to severe anterior chest pain, wheezing and dyspnea. She experienced sudden chest pain that gradually became more severe, accompanied by vomitting, wheezing, coughing and dyspnea. She had been asymptomatic until two years prior to admission, when wheezing and dyspnea began. Her serum IgE level was 2139 IU/ml, and both a skin test and a radioallergosorbent test (RASP were positive against house dust mites. According to episodic symptoms of wheezing and dyspnea, the patient showed a reversible airway response with an increase in forced expiratory volume in one second (FEV1) exceeding 20% in response to beta 2-agonist and showed increased bronchial hyperresponsiveness to methacholine (PC2O; the concentration of methacholine causing a 20% decline of FEV1, 390 µg/ml). She was diagnosed as having bronchial asthma. Other potential causes of the chest pain were ruled out according to the findings of upper gastrointestinal endoscopy, chest radiography, chest computed tomography, electrocardiogram and ultrasonic cardiography. Coronary angiography also failed to reveal either stenosis or atherosclerotic changes.
 
Gastroesophageal reflux disease was also concluded to be an unlikely cause of the chest pain given that a proton pump inhibitor was not effective in reducing the chest pain. After being admitted, she was treated with corticosteroids, nebulized beta 2-agonist and intravenous aminophylline for her wheezing and dyspnea, and a nonsteroidal anti- inflammatory suppository for the chest pain.
 
Following discharge, although the frequency of chest pain decreased, she began to experience frequent episodes of yawning at night accompanied by tears. Her yawning occurred once every thirty to forty minutes, especially on cold nights from November to March with no sensation of dyspnea or chest pain. Her pulmonary function was normal (114,5 % of predicted forced vital capacity (FVC) , 113.8 % of predicted FEV,) when she was asymptomatic.
 
While she experienced yawning, although PEF (peak expiratory flow) decreased somewhat (50-80% of her maximum level), no asthmatic symptoms, such as wheezing or dyspnea were observed. The yawning was improved markedly by bronchodilators and a leukotriene receptor antagonist, and moderately improved by corticosteroids. In summary, three different symptoms, namely wheezing and dyspnea, anterior chest pain and yawning, were observed in the present case.
 
Yawning is a complex behavioral event that depends largely on the autonomic nervous system, which has been reported to be associated with a sympathetic suppression that favours a parasympathetic dominance (1). Yawning is under the control of several neurotransmitters and neuropeptides at the central level. Substances that induce yawning include dopamine, excitatory amino acids, acetylcholine, serotonin, nitric oxide, adrenocorticotropic hormone-related peptides and oxytocin. Opioid peptides are known to inhibit yawning (2). Despite recent progress, little is known of the neurochemical mechanisms underlying yawning at the central level. The administration of dexamethasone altered yawning behavior induced by cholinergic but not dopaminergic agonists (3). Further research is needed to identify these factors.
 
Asthma shows a wide variety of clinical manifestations, one of which is chest pain. Three reported cases of chest pain variant asthma have suggested its importance as a clinical entity for patients who initially present with chest pain. Two patients required a short course oral corticosteroid treatment to achieve symptom ablation (4). Asthma symptoms (cough, dyspnea, wheeze, chest tightness, sputum production and nocturnal awakening) correlated poorly with the level of airway obstruction (5). However, the present case developed nocturnal yawning associated with noncardiac and nonesophageal chest pain and airway obstruction. The reason for the occurrence of yawning and chest pain remains obscure, but the autonomic nerve system may have played an important role in their occurrence. Our case suggests that yawning is a clinical manifestation of asthma that responds to treatment.
 
References
 
1 . Askenasy JJ, Askenasy N. Inhibition of muscle sympathetic nerve activity during yawning. Clin Auton Res 1996;6:237-239.
 
2. Argiolas A, Meus MR. The neuropharmacology of yawning. Eur J Pharmacol 1998;343:1-16.
 
3. Hipolide DC, Lobo LL, De Medeiros R, Neumann B, Tufik S. Treatment with dexamethasone alters yawning behavior induced by cholinergic but not dopaminergic agonist. Physiol Behav 1999;65:829-832.
 
4. Whitney EJ, Row JM, Boswell RN. Chest pain variant asthma. Ann Emerg Med 1983;12:572-575.
 
5. Teeter JG, Bleecker ER. Relationship between airway obstruction and respiratory symptoms in adult asthmatics. Chest 1998;113:272-277.