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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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Stojanovic S, Zubrinich C, Sverrild A, Mahoney J, Denton E, Lee J, Hew M. Laryngoscopy diagnosis of inducible laryngeal obstruction during supervised challenge for suspected anaphylaxis. Clin Exp Allergy 2022; 52:924-928. [PMID: 35535788 DOI: 10.1111/cea.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Stephanie Stojanovic
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Celia Zubrinich
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Asger Sverrild
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Janine Mahoney
- Speech Pathology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Eve Denton
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joy Lee
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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