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Majellano EC, Clark VL, Vertigan A, Gibson PG, Bardin P, Leong P, McDonald VM. Living With Asthma and Vocal Cord Dysfunction/Inducible Laryngeal Obstruction: "I Just Can't Get Air In". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1326-1336. [PMID: 38290607 DOI: 10.1016/j.jaip.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Asthma and vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO), may coexist, resulting in worse outcomes for patients. The experience of people with VCD/ILO and coexisting asthma is unknown. OBJECTIVE We sought to determine whether coexistent VCD/ILO and asthma have deleterious impacts on quality of life. METHODS We undertook a descriptive qualitative study using one-to-one semistructured interviews with 30 purposively recruited adult participants with a prior confirmed doctor asthma diagnosis and laryngoscopy-confirmed VCD/ILO. A thematic and content analysis was conducted to explore the data. RESULTS Participants were mostly female (63%), mean ± SD age 63 ± 12 years. Four themes were identified: trapped voice, altered life, knowledge about VCD/ILO, and looking for solutions. Participants reported their voice being trapped in their throat or the voice being suddenly cut off when talking or singing. Self-reported VCD/ILO symptoms including throat tightness and breathlessness were highlighted by participants. The second theme described how patients struggle to communicate or tended to shorten conversations. Insufficient knowledge and existing confusion regarding whether asthma was causing the breathlessness was described in the third theme. Looking for solutions depicted participants' diagnostic journey and how they sought an explanation for the symptoms. CONCLUSIONS People with asthma and coexisting VCD/ILO experience a substantial burden affecting the quality of life. These data describe the impact on patients with coexisting conditions and should be used to increase clinician awareness of the experience of VCD/ILO from patients' perspectives to support a personalized approach to care.
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Affiliation(s)
- Eleanor C Majellano
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anne Vertigan
- National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; Speech Pathology Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Philip Bardin
- Monash Lung, Sleep, Allergy and Immunology, Monash Health and Monash University, Melbourne, Victoria, Australia; School of Clinical Sciences, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung, Sleep, Allergy and Immunology, Monash Health and Monash University, Melbourne, Victoria, Australia; School of Clinical Sciences, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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Quigley N, Mistry SG, Vasant DH, Vasani S. Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms. BMJ Open Gastroenterol 2023; 10:e000883. [PMID: 37996120 PMCID: PMC10668155 DOI: 10.1136/bmjgast-2022-000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation. DESIGN This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches. RESULTS The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed. CONCLUSION Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.
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Affiliation(s)
- Nathan Quigley
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Sandeep G Mistry
- Department of Ear Nose and Throat, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarju Vasani
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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Leong P, Gibson PG, Vertigan AE, Hew M, McDonald VM, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction-2022 Melbourne Roundtable Report. Respirology 2023; 28:615-626. [PMID: 37221142 PMCID: PMC10947219 DOI: 10.1111/resp.14518] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi-factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence-based standard of care since randomized trials for treatment are non-existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.
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Affiliation(s)
- Paul Leong
- Monash HealthMelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
| | - Peter G. Gibson
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Anne E. Vertigan
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Mark Hew
- Alfred HospitalMelbourneVictoriaAustralia
| | - Vanessa M. McDonald
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Philip G. Bardin
- Monash HealthMelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
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Reddel HK. Common conditions that mimic asthma. Med J Aust 2022; 216:337-340. [PMID: 35342957 PMCID: PMC9313614 DOI: 10.5694/mja2.51467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/17/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Helen K Reddel
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW
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Tidmarsh B, Marinho S, Haines J, Fowler SJ. Differentiating Throat Symptoms in Inducible Laryngeal Obstruction From Anaphylaxis-Information for Patients and Health Care Professionals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:645-646. [PMID: 35144776 DOI: 10.1016/j.jaip.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Bethany Tidmarsh
- Department of Respiratory Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Susana Marinho
- Allergy Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jemma Haines
- Department of Respiratory Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen J Fowler
- Department of Respiratory Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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Denton E, Hew M, Gibson PG, Vertigan A. Lone Ranger or Handpicked Posse? How Multidisciplinary Assessment Helps Evaluate Suspected Laryngeal Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:609-611. [PMID: 35144775 DOI: 10.1016/j.jaip.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, VIC, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, VIC, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Treatable Traits, the University of Newcastle, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Anne Vertigan
- Speech Pathology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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