1
|
Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024; 166:171-186. [PMID: 38508333 DOI: 10.1016/j.chest.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
TOPIC IMPORTANCE Laryngeal dysfunction as a cause of chronic refractory cough and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. REVIEW FINDINGS The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. SUMMARY Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of chronic refractory cough and dyspnea. Recognition of laryngeal hypersensitivity in the patient with chronic refractory cough can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
Collapse
Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology-Head & Neck Surgery & Voice Disorders Center, University of Utah, Salt Lake City, UT
| | - Michael J Morris
- Pulmonary & Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
| |
Collapse
|
2
|
Ludlow S, Holmes LJ, Simpson L, Fowler SJ, Byrne-Davis L. Protocol for a scoping review to map health outcomes in individuals with inducible laryngeal obstruction. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1398-1403. [PMID: 38227644 DOI: 10.1111/1460-6984.13007] [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: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time. METHODS This study is a scoping review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The review will be guided by the following research question: 'What health outcomes are measured in studies including people with inducible laryngeal obstruction?' The research question was validated using the Population-Concept-Context framework according to the methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies and grey literature conducted over the last 40 years will be identified from electronic databases including AMED, CINAHL, Embase, EMCARE, MEDLINE, OVID, PubMed and PsycINFO. The search strings 'inducible laryngeal obstruction', 'ILO', 'vocal cord dysfunction', 'VCD', 'paradoxical vocal fold motion', 'PVFM', 'outcome', 'measure', 'measurement instrument', 'assessment', 'scale', 'questionnaire' will be combined using Boolean logic. An independent reviewer will conduct title screening; two independent reviewers will conduct abstract and full article screening, followed by data extraction by two reviewers. Analyses will be conducted appropriate to the findings. DISCUSSION The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools, and for standardisation for clinical and research purposes. WHAT THIS PAPER ADDS What is already known on the subject Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time. Currently, there are no standardised outcome measures for measuring the effects of interventions in inducible laryngeal obstruction (ILO). What this paper adds to existing knowledge Assessment of health can be measured in a variety of ways. Physiological, radiological and biochemical measurements of impairment are more common historically but there are a lot of outcomes of other factors now including subjective measures of functional status and health-related quality of life, with data collected directly from patients. This study will allow us to scope the literature to see the health outcomes being measured in ILO to attempt to standardise and develop future health outcomes. What are the potential or actual clinical implications of this work? The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools and for standardisation for clinical and research purposes.
Collapse
Affiliation(s)
- Siobhan Ludlow
- Manchester University NHS Foundation, Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Leanne-Jo Holmes
- Manchester University NHS Foundation, Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | | | - Stephen J Fowler
- Manchester University NHS Foundation, Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | | |
Collapse
|
3
|
Sundar KM, Stark AC, Dicpinigaitis P. Chronic Cough and Obstructive Sleep Apnea. Sleep Med Clin 2024; 19:239-251. [PMID: 38692749 DOI: 10.1016/j.jsmc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Chronic cough, defined as a cough lasting more than 8 weeks, is a common medical condition occurring in 5% to 10% of the population. Its overlap with another highly prevalent disorder, obstructive sleep apnea (OSA), is therefore not surprising. The relationship between chronic cough and OSA extends beyond this overlap with higher prevalence of OSA in patients with chronic cough than in the general population. The use of continuous positive airway pressure can result in improvement in chronic cough although further studies are needed to understand which patients will experience benefit in their cough from the treatment of comorbid OSA.
Collapse
Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary & Critical Care Medicine, 30 N, Mario Capecchi Drive, 2nd floor North, University of Utah, Salt Lake City, UT 84112, USA.
| | - Amanda Carole Stark
- Voice Disorders Center, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84106, USA
| | - Peter Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| |
Collapse
|
4
|
Aigbirior J, Almaghrabi A, Lafi M, Mansur AH. The role of radiological imaging in the management of severe and difficult-to-treat asthma. Breathe (Sheff) 2024; 20:240033. [PMID: 39015661 PMCID: PMC11249838 DOI: 10.1183/20734735.0033-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/12/2024] [Indexed: 07/18/2024] Open
Abstract
Radiological imaging has proven to be a useful tool in the assessment of asthma, its comorbidities and potential complications. Characteristic chest radiograph and computed tomography scan findings can be seen in asthma and in other conditions that can coexist with or be misdiagnosed as asthma, including chronic rhinosinusitis, inducible laryngeal obstruction, excessive dynamic airway collapse, tracheobronchomalacia, concomitant COPD, bronchiectasis, allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis with polyangiitis, and eosinophilic pneumonia. The identification of the characteristic radiological findings of these conditions is often essential in making the correct diagnosis and provision of appropriate management and treatment. Furthermore, radiological imaging modalities can be used to monitor response to therapy.
Collapse
Affiliation(s)
- Joshua Aigbirior
- Department of Respiratory Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amer Almaghrabi
- Department of Respiratory Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Monder Lafi
- Medical School, Lancaster University, Lancaster, UK
| | - Adel H. Mansur
- Department of Respiratory Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| |
Collapse
|
5
|
Walsh E, Krause AJ, Greytak M, Kaizer AM, Weissbrod PA, Liu K, Taft T, Yadlapati R. Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients With Suspected Laryngopharyngeal Reflux Disease. Am J Gastroenterol 2024:00000434-990000000-01134. [PMID: 38656937 DOI: 10.14309/ajg.0000000000002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement, or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. The aim of this study was to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms undergoing evaluation of gastroesophageal reflux disease (GERD). METHODS Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included ≥2 SLP-directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient-reported outcomes were collected when available. The primary outcome was symptom response. RESULTS Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6 kg/m 2 (6.8), and mean of 3.7 (1.9) LRT sessions. Overall, 55 participants (85%) met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15, 87%) and concomitant laryngopharyngeal/esophageal symptoms (42/50, 84%). Among participants who underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 [86%], 8/9 [89%], 10/13 [77%]). DISCUSSION Eighty-five percent of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation who underwent LRT-experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD and patients with or without concomitant esophageal reflux symptoms. SLP-directed LRT is an effective approach to incorporate into multidisciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.
Collapse
Affiliation(s)
- Erin Walsh
- Department of Otolaryngology, University of California San Diego, La Jolla, California, USA
| | - Amanda J Krause
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Madeline Greytak
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Alexander M Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Philip A Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, California, USA
| | - Kelli Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Tiffany Taft
- The Rome Foundation Research Institute, Chapel Hill, North Carolina, USA
| | - Rena Yadlapati
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
6
|
Ibrahim Y, Young K, Gane J, Judd O. A woman with recurrent spontaneous throat swelling. BMJ 2024; 385:e078481. [PMID: 38724082 DOI: 10.1136/bmj-2023-078481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Yousef Ibrahim
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
| | - Kate Young
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
| | - Jennie Gane
- Respiratory Department, Royal Derby Hospital, Derby, UK
| | - Owen Judd
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
| |
Collapse
|
7
|
Karkouli G, Douros K, Moriki D, Moutsatsou P, Giannopoulou I, Maratou E, Koumpagioti D. Dysfunctional Breathing in Children: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:556. [PMID: 38790551 PMCID: PMC11120484 DOI: 10.3390/children11050556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
Dysfunctional breathing (DB) describes a respiratory condition that is mainly characterized by abnormal breathing patterns, affecting both children and adults, often leading to intermittent or chronic complaints and influencing physiological, psychological, and social aspects. Some symptoms include breathlessness; dizziness; palpitations; and anxiety, while its classification lies in breathing pattern disorders and upper airway involvement. Its prevalence among the pediatric population varies with a female overrepresentation, while the existence of comorbidities in DB, such as asthma, gastro-esophageal reflux, nasal diseases, and anxiety/depression, frequently leads to misdiagnosis or underdiagnosis and complicates therapeutic approaches. The basic diagnostic tools involve a detailed history, physical examination, and procedures such as structured light plethysmography, cardiopulmonary exercise testing, and laryngoscopy when a laryngeal obstruction is present. The management of DB presumes a multidimensional approach encompassing breathing retraining, disease-specific advice through speech and language therapy in the presence of laryngeal obstruction, psychotherapy for fostering self-efficacy, and surgical therapy in a structural abnormality. The current review was developed to provide a summary of classifications of DB and epidemiological data concerning the pediatric population, comorbidities, diagnostic tools, and therapeutic approaches to enhance the comprehension and management of DB in children.
Collapse
Affiliation(s)
- Georgia Karkouli
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.K.); (D.M.)
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.K.); (D.M.)
| | - Dafni Moriki
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.K.); (D.M.)
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.M.); (E.M.)
| | - Ioanna Giannopoulou
- Department of Psychiatry, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Eirini Maratou
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.M.); (E.M.)
| | - Despoina Koumpagioti
- Department of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Haines J, Simpson AJ, Slinger C, Selby J, Pargeter N, Fowler SJ, Hull JH. Clinical Characteristics and Impact of Inducible Laryngeal Obstruction in the UK National Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1337-1343. [PMID: 38296051 DOI: 10.1016/j.jaip.2024.01.030] [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: 09/08/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Inducible laryngeal obstruction (ILO) describes inappropriate laryngeal closure during respiration, with airflow obstruction occurring at the glottic and/or supraglottic level, leading to breathlessness. OBJECTIVE There is a paucity of data describing the demographics and impact of ILO. We aimed to report the clinical and demographic features of ILO in individuals entered prospectively in the UK national ILO registry. METHODS Data were entered into a Web-based registry from participants with endoscopically confirmed ILO who were attending four established UK-wide specialist ILO centers between March 2017 and November 2019. All patients provided written informed consent. RESULTS Data from 137 individuals were included. Most (87%) had inspiratory ILO and required provocation during endoscopy to induce symptoms. There was a female predominance (80%), mean age 47 years (SD, 15 years). The most common comorbidities included asthma (68%) and reflux (57%). Health care use was high: 88% had attended emergency health care with symptoms at least once in the previous 12 months and nearly half had been admitted to the hospital. A fifth had required admission to critical care owing to ILO symptoms. Patient morbidity was substantial; 64% reported impaired functional capacity (≥3 on the Medical Research Council Dyspnoea Scale) and a third stated that symptoms affected working capability. CONCLUSION We describe the first multicenter prospective characterization of individuals with endoscopically diagnosed ILO. Analysis of our multicenter data set identified ILO as associated with a high burden of morbidity and health care use, comparable to severe asthma. These data will support the development of health care resources in the future and guide research priorities.
Collapse
Affiliation(s)
- Jemma Haines
- Faculty of Biology, Medicine, and Health, School of Biological Sciences, Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; NIHR-Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - Andrew J Simpson
- School of Sport, Exercise, and Rehabilitation Sciences, University of Hull, Hull, United Kingdom
| | - Claire Slinger
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, United Kingdom
| | - Julia Selby
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Nicola Pargeter
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephen J Fowler
- Faculty of Biology, Medicine, and Health, School of Biological Sciences, Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; NIHR-Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Institute of Sport, Exercise, and Health, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| |
Collapse
|
10
|
Mahoney J, Vertigan A, Hew M, Oates J. Exploring Factors Impacting Engagement in Speech Pathology Intervention for Inducible Laryngeal Obstruction. J Voice 2024:S0892-1997(24)00079-1. [PMID: 38565469 DOI: 10.1016/j.jvoice.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
AIM Speech pathology is the first-line treatment for inducible laryngeal obstruction (ILO) and involves behavioral techniques to address symptoms and modify maladaptive laryngeal postures. Benefit from speech pathology is reliant on patients engaging in treatment sessions, regular home practice, and generalizing techniques to everyday activities. There is limited research exploring engagement in speech pathology treatment for ILO, particularly from the patient perspective. This study aimed to explore the experiences of living with ILO and how this experience may impact the way patients engage in speech pathology treatment. STUDY DESIGN Qualitative study. METHODS Semistructured interviews were completed with seven participants exploring their experiences living with ILO, their diagnostic process and their experiences with speech pathology treatment. Data were analyzed using reflexive thematic analysis to determine shared meanings across participants and themes were developed. FINDINGS Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Patients' reports of living with ILO and interacting with speech pathology suggested that these experiences impacted their readiness to start treatment and persist through the challenges of the treatment. Engagement appeared to be positively associated with significant ILO symptom burden and life impact, confidence in the diagnostic process, recommendation for speech pathology treatment, a tailored intervention by a patient-perceived expert in the field and working in a partnership with the speech pathologist to develop a sense of agency. Patients indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom burden and life impact. CONCLUSION The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient-centered approach to therapy may help to maximize engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximize engagement in treatment for people with ILO.
Collapse
Affiliation(s)
- Janine Mahoney
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia; Speech Pathology Department, The Alfred, Melbourne, Victoria, Australia.
| | - Anne Vertigan
- Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, The Alfred, Melbourne, Victoria, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Oates
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Yap G, Ruane LE, Hamza K, Leahy E, Avram A, Baxter M, Koh J, Bardin PG, Leong P. Vocal cord dysfunction/inducible laryngeal obstruction cannot be diagnosed from symptoms. ERJ Open Res 2023; 9:00707-2023. [PMID: 38152087 PMCID: PMC10752286 DOI: 10.1183/23120541.00707-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/29/2023] Open
Abstract
Vocal cord dysfunction/inducible laryngeal obstruction is highly variable. Standard clinical symptoms and questionnaires cannot predict laryngoscopic diagnosis in a "lung disease" population. https://bit.ly/3QUtsbB.
Collapse
Affiliation(s)
- Grace Yap
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
| | - Laurence E. Ruane
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Leahy
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
| | - Adriana Avram
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
| | - Malcolm Baxter
- Monash University, Melbourne, Victoria, Australia
- Ear, Nose, Throat Surgery, Monash Health, Clayton, Victoria, Australia
| | - Joo Koh
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Ear, Nose, Throat Surgery, Monash Health, Clayton, Victoria, Australia
| | - Philip G. Bardin
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy and Immunology, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Novaleski CK, Doty RL, Nolden AA, Wise PM, Mainland JD, Dalton PH. Examining the Influence of Chemosensation on Laryngeal Health and Disorders. J Voice 2023; 37:234-244. [PMID: 33455853 PMCID: PMC8277875 DOI: 10.1016/j.jvoice.2020.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Inhaled airborne stimuli are associated with laryngeal disorders affecting respiration. Clinically, several themes emerged from the literature that point to specific gaps in the understanding and management of these disorders. There is wide variation in the types of airborne stimuli that trigger symptoms, lack of standardization in provocation challenge testing using airborne stimuli, and vague reporting of laryngeal symptoms. Scientifically, evidence exists outside the field of voice science that could prove useful to implement among patients with impaired laryngeal-respiration. To expand this area of expertise, here we provide a thematic overview of relevant evidence and methodological tools from the discipline of chemosensory sciences. This review provides distinctions across the three chemosensory systems of olfaction, trigeminal chemesthesis, and gustation, guidance on selecting and delivering common chemosensory stimuli for clinical testing, and methods of quantifying sensory experiences using principles of human psychophysics. Investigating the science of chemosensation reveals that laryngeal responses to inhaled airborne stimuli have explanations involving physiological mechanisms as well as higher cognitive processing. Fortunately, these findings are consistent with current pharmacological and nonpharmacological interventions for impaired laryngeal-respiration. Based on the close relationships among inhaled airborne stimuli, respiration, and laryngeal function, we propose that new perspectives from chemosensory sciences offer opportunities to improve patient care and target areas of future research.
Collapse
Affiliation(s)
- Carolyn K Novaleski
- Monell Chemical Senses Center, Philadelphia, Pennsylvania; Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan; Department of Neurology, Mayo Clinic, Rochester, Minnesota.
| | - Richard L Doty
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alissa A Nolden
- Department of Food Science, University of Massachusetts-Amherst, Amherst, Massachusetts
| | - Paul M Wise
- Monell Chemical Senses Center, Philadelphia, Pennsylvania
| | - Joel D Mainland
- Monell Chemical Senses Center, Philadelphia, Pennsylvania; Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
15
|
Vanderaa V, Vinney LA. Laryngeal Sensory Symptoms in Spasmodic Dysphonia. J Voice 2023; 37:302.e1-302.e12. [PMID: 33485747 DOI: 10.1016/j.jvoice.2020.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this research was to determine whether an association between laryngeal hypersensitivity (LH) and spasmodic dysphonia (SD) exists using the LH Questionnaire (LHQ). This study also explored the prevalence of self-reported upper respiratory infection (URI) at the time of SD onset across SD phenotypes. METHODS Individuals with and without SD were recruited to complete an online survey measure. All respondents provided demographic information and completed the LHQ. Participants with SD were also asked to provide information about their diagnosed SD subtype and pattern of onset, including whether onset was associated with a URI. The percentage of respondents with and without SD who were classified with LH was determined based on the LHQ. Scores on the LHQ were also compared between the non-SD and the SD groups, as well as between SD phenotypes (adductor SD, abductor SD, and mixed)). RESULTS AND CONCLUSIONS Significant associations were found between ADSD and LH, mixed SD and LH, and URI at time of SD onset and increased severity of LH symptoms. These findings suggest that laryngeal sensory symptoms may potentially contribute to or result from motor spasms in SD and/or have implications for its pathophysiology.
Collapse
Affiliation(s)
| | - Lisa A Vinney
- Department of Communication Sciences and Disorders, Illinois State University, Normal, Illinois.
| |
Collapse
|
16
|
Varelas EA, Hwang C, Brown S, Chang J, Sataluri M, Kirke D, Courey M, Goldberg L. Standardized Behavioral Treatment Improves Chronic Cough. J Voice 2023:S0892-1997(22)00369-1. [PMID: 36642591 DOI: 10.1016/j.jvoice.2022.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Neurogenic Laryngeal Hypersensitivity (NLH) refers to a constellation of upper airway symptoms thought to be caused by a disturbance in afferent and/or efferent neural pathways creating an exaggerated hypersensitive laryngeal response. There is evidence to support behavioral therapy as treatment for improving symptoms from laryngeal motor dysfunction to sensory disturbance. This study aims to determine if there is significant symptomatic improvement in patients with NLH who received non-pharmacologic behavioral treatment performed by trained SLPs. STUDY DESIGN A retrospective review. METHODS A review of all patients with NLH from 2017 to 2020 was performed at a tertiary care voice and swallowing center. Subjects with persistent symptoms despite maximal medical management were considered for inclusion. Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) was completed by patients before and after undergoing therapy by one of three trained SLPs. Posttherapy improvement was determined by utilizing the NLHQ's minimal clinically important difference of 1.7 points. RESULTS A total of 81 patients were included in this study. Study participants included 61 women and 20 men with an average age of 60.64±14.05 years. There was a statistically significant difference between the pre and post therapy scores amongst all patients when treated by each individual SLP and all three SLPs combined (P < 0.008). There was a clinically significant change in 66% of all patients, 76% of which presented with abnormal NLHQ scores, and 14% who presented with normal NLHQ scores. CONCLUSIONS A standardized behavioral treatment protocol for patients with symptoms consistent with NLH is effective in improving symptoms in a large majority of patients. When following a standardized protocol SLPs can obtain similar results for their patients.
Collapse
Affiliation(s)
- Eleni A Varelas
- Division of Laryngology, Department of Otolaryngology- Head and Neck Surgery, Mount Sinai Health System, New York, New York.
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sarah Brown
- Division of Laryngology, Department of Otolaryngology- Head and Neck Surgery, Mount Sinai Health System, New York, New York
| | - Joseph Chang
- The Permanente Medical Group, Department of Head and Neck Surgery, Kaiser Permanente Santa Clara, Santa Clara, California
| | - Medha Sataluri
- Northwestern Medicine, Department of Otolaryngology, Chicago, Illinois
| | - Diana Kirke
- Division of Laryngology, Department of Otolaryngology- Head and Neck Surgery, Mount Sinai Health System, New York, New York
| | - Mark Courey
- Division of Laryngology, Department of Otolaryngology- Head and Neck Surgery, Mount Sinai Health System, New York, New York
| | - Leanne Goldberg
- Division of Laryngology, Department of Otolaryngology- Head and Neck Surgery, Mount Sinai Health System, New York, New York
| |
Collapse
|
17
|
Koh J, Phyland D, Baxter M, Leong P, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics. Expert Rev Respir Med 2023; 17:429-445. [PMID: 37194252 DOI: 10.1080/17476348.2023.2215434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based. AREAS COVERED A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure. EXPERT OPINION Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.
Collapse
Affiliation(s)
- Joo Koh
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Debra Phyland
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Malcolm Baxter
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
| |
Collapse
|
18
|
Chronic cough comes of age. Ann Allergy Asthma Immunol 2023; 130:4-5. [PMID: 36596612 DOI: 10.1016/j.anai.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023]
|
19
|
Licari A, Andrenacci B, Di Cicco ME, Leone M, Marseglia GL, Tosca M. Respiratory comorbidities in severe asthma: focus on the pediatric age. Expert Rev Respir Med 2023; 17:1-13. [PMID: 36631726 DOI: 10.1080/17476348.2023.2168261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Asthma comorbidities are a frequent cause of adverse outcomes, such as poor asthma control, frequent asthma attacks, reduced quality of life, and higher healthcare costs. Comorbidities are well-known treatable traits whose proper management can help achieve optimal asthma control. Although multimorbidity is frequent among asthmatics, comorbidities are still a potential cause of misdiagnosis and under or over treatments, and little is known about their impact on severe pediatric asthma. AREAS COVERED We provided a comprehensive, 5-year updated review focusing on the main respiratory comorbidities in severe asthma, particularly in epidemiology, pathogenesis, and current and future therapies. EXPERT OPINION Respiratory comorbidities have unique characteristics in childhood. Their management must be multidisciplinary, age-specific, and integrated. Further longitudinal studies are needed to understand better the mutual interrelation and synergistic effect between asthma and its respiratory comorbidities, the identification of common, treatable risk factors leading to potential asthma prevention, the effectiveness of actual and future target-therapies, and the correlation between long-lasting respiratory comorbidities and poor lung function trajectories.
Collapse
Affiliation(s)
- Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariangela Tosca
- Allergy Centre, IRCCS G. Gaslini Pediatric Hospital, Genova, Italy
| |
Collapse
|
20
|
Held T, Franke H, Lang K, Eichkorn T, Regnery S, Weusthof K, Bauer L, Plath K, Dyckhoff G, Plinkert PK, Harrabi SB, Herfarth K, Debus J, Adeberg S. Intensity modulated proton therapy for early-stage glottic cancer: high-precision approach to laryngeal function preservation with exceptional treatment tolerability. Radiat Oncol 2022; 17:199. [PMID: 36471398 PMCID: PMC9724307 DOI: 10.1186/s13014-022-02144-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Due to the increasing expertise in transoral laser surgery and image-guided radiation therapy, treatment outcomes have recently improved in patients with early-stage glottic cancer. The objective of the current study was to evaluate intensity-modulated proton therapy (IMPT) as novel treatment option. METHODS A total of 15 patients with T1-2N0 glottic squamous cell carcinoma, treated between 2017 and 2020, were evaluated. Toxicity was recorded according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.03. RESULTS The majority were T1a/b tumors (66.7%) and no patient had lymph node or distant metastases. The median total dose was 70 Gy relative biological effectiveness (RBE) (range 66-70 Gy RBE). The one- and two-year OS and metastases-free survival were 100%. One patient developed local failure and received salvage laryngectomy. No higher-grade acute or late toxicity was reported. The mean number of CTCAE grade I and II overall toxicity events per patient was 4.1 (95%-[confidence interval] CI 3.1-5.3) and 1.0 (95%-CI 0.5-1.5). CONCLUSION High-precision proton therapy of T1-2N0 glottic cancer resulted in exceptional treatment tolerability with high rates of laryngeal function preservation and promising oncological outcome. IMPT has the potential to become a standard treatment option for patients with early-stage laryngeal cancer.
Collapse
Affiliation(s)
- Thomas Held
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Henrik Franke
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Kristin Lang
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Tanja Eichkorn
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Sebastian Regnery
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Katharina Weusthof
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Lukas Bauer
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Karim Plath
- grid.7700.00000 0001 2190 4373Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Dyckhoff
- grid.7700.00000 0001 2190 4373Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Peter K. Plinkert
- grid.7700.00000 0001 2190 4373Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Semi B. Harrabi
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Herfarth
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- grid.5253.10000 0001 0328 4908Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany ,grid.488831.eHeidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany ,grid.461742.20000 0000 8855 0365National Center for Tumor diseases (NCT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
21
|
Kim JF, Watson W, Becerra BJ, Crawley BK, Saab R, Krishna P, Murry T. The Diagnosis and Time of Onset of Voice Disorders in Patients with Chronic Cough. J Voice 2022:S0892-1997(22)00298-3. [PMID: 36357238 DOI: 10.1016/j.jvoice.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Chronic cough is a complaint of up to 46% of patients referred to specialist clinics. Patients with cough often report hoarseness at the time of the cough diagnosis. When the cough fails to resolve with standard medications, referrals to other specialists including otolaryngologists are made. This is the first study to report the specific diagnosis and length of time it took to obtain a specific voice disorder diagnosis in patients with chronic cough. STUDY DESIGN Case Series METHODS: The charts of 105 patients referred to the Loma Linda Voice and Swallowing Center were reviewed. The first complaint of cough and/or hoarseness and the specific voice disorder diagnosis following otolaryngologic evaluation were identified. Voice disorders were divided into neurogenic or other/functional disorders and common comorbidities were identified. Statistical analysis between diagnostic groups, gender, and age were obtained. RESULTS The specific voice disorders in the cohort were identified. There was a high prevalence of neurogenic voice disorders (n = 85, 81%). There were significant relationships between chronic cough and the two most common neurogenic voice disorders, vocal fold paresis and vocal fold atrophy. The average length of time between complaint of hoarseness and the specific voice disorder diagnosis was 32.3 months. Most patients (86%) complained of voice problems after diagnosis of chronic cough. A significant association was found in prevalence of asthma (OR = 4.52, P = 0.02) and dyspnea (OR = 4.24, P = 0.02) in the cohort who presented first with voice complaints and later developed chronic cough. CONCLUSIONS There is a high incidence of neurogenic voice disorders accompanying patients with chronic cough. Understanding the relationship between chronic cough and hoarseness provides the clinician with specific diagnostic information in the treatment of both disorders.
Collapse
Affiliation(s)
- Jessica F Kim
- Loma Linda University School of Medicine, Loma Linda, CA.
| | - WayAnne Watson
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Benjamin J Becerra
- California State University, Center for Health Equity Department of Information & Decision Sciences, San Bernardino, CA
| | - Brianna K Crawley
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Rim Saab
- Drexel University School of Medicine, Philadelphia, PA
| | - Priya Krishna
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA
| | - Thomas Murry
- Loma Linda University Medical Center Department of Otolaryngology-Head and Neck Surgery, Loma Linda, CA; Drexel University College of Medicine Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA
| |
Collapse
|
22
|
Price OJ, Walsted ES, Bonini M, Brannan JD, Bougault V, Carlsen K, Couto M, Kippelen P, Moreira A, Pite H, Rukhadze M, Hull JH. Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy 2022; 77:2909-2923. [PMID: 35809082 PMCID: PMC9796481 DOI: 10.1111/all.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.
Collapse
Affiliation(s)
- Oliver J. Price
- School of Biomedical SciencesFaculty of Biological Sciences, University of LeedsLeedsUK
- Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Emil S. Walsted
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Department of Respiratory MedicineBispebjerg HospitalCopenhagenDenmark
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | | | | | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway
- Faculty of Medicine, University of OsloInstitute of Clinical MedicineOsloNorway
| | - Mariana Couto
- Allergy CenterCUF Descobertas HospitalLisbonPortugal
| | - Pascale Kippelen
- Division of Sport, Health and Exercise SciencesCollege of Health, Medicine and Life Sciences, Brunel University LondonUK
| | - André Moreira
- Centro Hospitalar Universitário de São JoãoPortoPortugal
- Epidemiology Unit (EPIUnit)Laboratory for Integrative and Translational Research in Population Health (ITR)Basic and Clinical Immunology, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalCEDOC, NOVA University, Universidade NOVA de LisboaLisbonPortugal
| | | | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Institute of Sport, Exercise and Health (ISEH)Division of Surgery and Interventional Science, University College London (UCL)LondonUK
| |
Collapse
|
23
|
Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
Collapse
Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
| |
Collapse
|
24
|
Haines J, Smith JA, Wingfield-Digby J, King J, Yorke J, Fowler SJ. Systematic review of the effectiveness of non-pharmacological interventions used to treat adults with inducible laryngeal obstruction. BMJ Open Respir Res 2022; 9:9/1/e001199. [PMID: 35705262 PMCID: PMC9204450 DOI: 10.1136/bmjresp-2022-001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Inducible laryngeal obstruction (ILO) describes transient laryngeal closure during respiration and can cause significant morbidity. Non-pharmacological behavioural therapy is the commonly cited treatment but efficacy is largely unknown. Aim To synthesise the current evidence base on the effectiveness of non-pharmacological interventions used to treat adults with ILO. Methods Electronic databases (Medline/Embase/CINAHL/PsycINFO/AMED/CENTRAL) were systematically searched, informed by a population, intervention, comparison, outcome framework. Two reviewers independently screened a representative sample, with lead-author completion due to excellent inter-rater reliability. Data was extracted using a predefined piloted form. Methodological quality was appraised (blindly by two reviewers) using the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was performed due to heterogeneity of studies (PROSPERO registration number: CRD42020213187). Results Initial searching identified 3359 records. Full-text screening occurred in 92 records and 14 studies, comprising 527 participants, were deemed eligible. All studies were low-level evidence (observational by design, with four case reports), with a high risk of bias; none contained control arms for comparison. Intervention description was inconsistently and poorly described but direction of effect was positive in 76% of outcomes measured. The majority of studies showed a reduction in symptom scores and improved direct laryngeal imaging post intervention; there was an overall reduction, 59.5%, in healthcare utilisation. Discussion The literature is in an embryonic state and lacks robust data to truly inform on the effectiveness of non-pharmacological interventions used to treat adults with ILO. However, positive signals in the synthesis performed support non-pharmacological treatment approaches and further development is warranted.
Collapse
Affiliation(s)
- Jemma Haines
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK .,Manchester Biomedical Research Unit, NIHR, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Jacklyn Ann Smith
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,Manchester Biomedical Research Unit, NIHR, Manchester, UK
| | - James Wingfield-Digby
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Jenny King
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | | | - Stephen J Fowler
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,Manchester Biomedical Research Unit, NIHR, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
25
|
Leong P, Al-Harrasi M, Carr B, Leahy E, Bardin PG, Barnes S. Vocal cord dysfunction/inducible laryngeal obstruction(s) mimicking anaphylaxis during SARS-CoV-2 (COVID-19) vaccination. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1380-1381. [PMID: 35257958 PMCID: PMC8896860 DOI: 10.1016/j.jaip.2022.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Paul Leong
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Mohammed Al-Harrasi
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Beau Carr
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Elizabeth Leahy
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Phillip G Bardin
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Sara Barnes
- Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
26
|
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
| |
Collapse
|
27
|
Park SY, Kang SY, Song WJ, Kim JH. Evolving Concept of Severe Asthma: Transition From Diagnosis to Treatable Traits. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:447-464. [PMID: 36174989 PMCID: PMC9523415 DOI: 10.4168/aair.2022.14.5.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
In recent decades, the concept of severe asthma has evolved from an umbrella term encompassing patients with high-intensity treatment needs to a clinical syndrome with heterogeneous, albeit distinct, pathophysiological processes. Biased and unbiased cluster approaches have been used to identify several clinical phenotypes. In parallel, cellular and molecular approaches allow for the development of biological therapies, especially targeting type 2 (T2) cytokine pathways. Although T2-biologics have significantly improved clinical outcomes for patients with severe asthma in real-world practice, questions on the proper use of biologics remain open. Furthermore, a subset of severe asthma patients remains poorly controlled. The unmet needs require a new approach. The “treatable traits” concept has been suggested to address a diversity of pathophysiological factors in severe asthma and overcome the limitations of existing treatment strategies. With a tailored therapy that targets the treatable traits in individual patients, better personalized medical care and outcomes should be achieved.
Collapse
Affiliation(s)
- So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University Gwangmyeong Medical Center, Gwangmyeong, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
28
|
Krause AJ, Walsh EH, Weissbrod PA, Taft TH, Yadlapati R. An update on current treatment strategies for laryngopharyngeal reflux symptoms. Ann N Y Acad Sci 2021; 1510:5-17. [PMID: 34921412 DOI: 10.1111/nyas.14728] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia. LPR is a challenging condition, as there is currently no gold standard for diagnosis or treatment, and thus this presents a burden to the healthcare system. Strategies for treatment of LPR are numerous. Medical therapies include proton pump inhibitors, which are first line, H2 receptor antagonists, alginates, and baclofen. Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device. Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication. Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without gastroesophageal reflux disease. Though there are minimal studies in this area, neuromodulators and behavioral interventions are potential treatment options. Given the complexity of these patients and numerous available treatment options, we propose a treatment algorithm to help clinicians diagnose and triage patients into an appropriate therapy.
Collapse
Affiliation(s)
- Amanda J Krause
- Division of Gastroenterology & Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Erin H Walsh
- Department of Otolaryngology, University of California San Diego, La Jolla, California
| | - Philip A Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, California
| | - Tiffany H Taft
- Division of Gastroenterology & Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rena Yadlapati
- Division of Gastroenterology & Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| |
Collapse
|
29
|
Vertigan AE, Bone SL, Gibson PG. The Impact of Functional Laryngoscopy on the Diagnosis of Laryngeal Hypersensitivity Syndromes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:597-601.e1. [PMID: 34666207 DOI: 10.1016/j.jaip.2021.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic cough and vocal cord dysfunction are manifestations of laryngeal hypersensitivity syndrome. OBJECTIVE The aim of the study was to determine the clinical utility of functional transnasal laryngoscopy in patients with laryngeal hypersensitivity syndromes. METHODS This study was a prospective observational cross-sectional study design of 71 participants with laryngeal hypersensitivity syndrome referred for functional transnasal laryngoscopy. Participants had a clinical assessment with a speech pathologist after which a provisional diagnosis of chronic cough, suspected vocal cord dysfunction, suspected muscle tension dysphonia, or a combination was made. A laryngoscopy with provocation was performed and the diagnosis revised after which the provisional and revised diagnoses were compared. RESULTS The diagnosis changed in 67% of participants after laryngoscopy. Vocal cord dysfunction was diagnosed in an additional 17 cases when not expected clinically but discounted when suspected clinically in 12 participants. Muscle tension dysphonia was diagnosed in an additional 31 cases when not suspected clinically and not confirmed when suspected in 2. CONCLUSION This study demonstrated that conditions such as muscle tension dysphonia and vocal cord dysfunction cannot be diagnosed based on symptoms alone. In addition to diagnostic accuracy, functional laryngoscopy enhances treatment planning and provides immediate feedback regarding laryngeal movement during respiration and phonation.
Collapse
Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia; Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Sarah L Bone
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory & Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| |
Collapse
|
30
|
Joo H, Moon JY, An TJ, Choi H, Park SY, Yoo H, Kim CY, Jeong I, Kim JH, Koo HK, Rhee CK, Lee SW, Kim SK, Min KH, Kim YH, Jang SH, Kim DK, Shin JW, Yoon HK, Kim DG, Kim HJ, Kim JW. Revised Korean Cough Guidelines, 2020: Recommendations and Summary Statements. Tuberc Respir Dis (Seoul) 2021; 84:263-273. [PMID: 33979988 PMCID: PMC8497763 DOI: 10.4046/trd.2021.0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/10/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient's quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.
Collapse
Affiliation(s)
- Hyonsoo Joo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tai Joon An
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - So Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lung and Esophageal Cancer Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Chi Young Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ina Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyeon-Kyoung Koo
- Divison of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sei Won Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Department of Pulmonary, Allergy, and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Wook Shin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gyu Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hui Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
31
|
Elibol E, Yılmaz YF, Ünal A, Ozcan M, Kum NY, Kum RO, Kulaçoğlu S. Effects of hyaluronic acid-collagen nanofibers on early wound healing in vocal cord trauma. Eur Arch Otorhinolaryngol 2021; 278:1537-1544. [PMID: 33616748 DOI: 10.1007/s00405-021-06703-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vocal cord scarring is the most crucial obstacle in voice quality after surgery. This study aimed to evaluate the effectiveness of hyaluronic acid (HA)-collagen nanofibers on the healing of vocal cords after surgical trauma. METHOD Right vocal cords of 12 New Zealand white rabbits were traumatized, and the experimental group was received 1.08 mg/75 ml topical HA-collagen nanofiber (Gelfix® spray) for 3 days. Three animals in each group were sacrificed on the 7th day, and the remaining of the animals were sacrificed on the 21st day. The laryngeal specimens in the experimental and control groups were examined histopathologically. RESULT The 7th-day H&E staining evaluation revealed pink, dense, and thin collagen fibers. Besides, the collagen content was scattered and irregular in the experimental group. The 21st-day assessment showed that the collagen bundles in the granulation tissue were almost with the same formation in both of the groups. Masson Trichrome staining on the 7th day of the study showed that the collagen fiber bundles were less frequent in the control group than the experimental group. The 7th-day Van Gieson staining analysis showed that the pattern of reticular fibers was more regular with the parallel formation in the experimental group than the control group. CONCLUSION HA-collagen nanofiber can be used in diseases that impair voice quality due to the thickening of the lamina propria layer in the vocal cord and impaired viscoelasticity due to fibrosis after tissue trauma.
Collapse
Affiliation(s)
- Elif Elibol
- Department of Ear, Nose and Throat Diseases, Ankara City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey.
| | - Yavuz Fuat Yılmaz
- Department of Ear, Nose and Throat Diseases, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | | | - Nurcan Yurtsever Kum
- Department of Ear, Nose and Throat Diseases, Ankara City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Rauf Oğuzhan Kum
- Department of Ear, Nose and Throat Diseases, Ankara City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Sezer Kulaçoğlu
- Department of Pathology, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
32
|
Ionescu MF, Mani-Babu S, Degani-Costa LH, Johnson M, Paramasivan C, Sylvester K, Fuld J. Cardiopulmonary Exercise Testing in the Assessment of Dysfunctional Breathing. Front Physiol 2021; 11:620955. [PMID: 33584339 PMCID: PMC7873943 DOI: 10.3389/fphys.2020.620955] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/14/2020] [Indexed: 01/07/2023] Open
Abstract
Dysfunctional breathing (DB) is a disabling condition which affects the biomechanical breathing pattern and is challenging to diagnose. It affects individuals in many circumstances, including those without underlying disease who may even be athletic in nature. DB can also aggravate the symptoms of those with established heart or lung conditions. However, it is treatable and individuals have much to gain if it is recognized appropriately. Here we consider the role of cardiopulmonary exercise testing (CPET) in the identification and management of DB. Specifically, we have described the diagnostic criteria and presenting symptoms. We explored the physiology and pathophysiology of DB and physiological consequences in the context of exercise. We have provided examples of its interplay with co-morbidity in other chronic diseases such as asthma, pulmonary hypertension and left heart disease. We have discussed the problems with the current methods of diagnosis and proposed how CPET could improve this. We have provided guidance on how CPET can be used for diagnosis, including consideration of pattern recognition and use of specific data panels. We have considered categorization, e.g., predominant breathing pattern disorder or acute or chronic hyperventilation. We have explored the distinction from gas exchange or ventilation/perfusion abnormalities and described other potential pitfalls, such as false positives and periodic breathing. We have also illustrated an example of a clinical pathway utilizing CPET in the diagnosis and treatment of individuals with suspected DB.
Collapse
Affiliation(s)
- Maria F Ionescu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sethu Mani-Babu
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Martin Johnson
- Golden Jubilee National Hospital, Clydebank, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom.,Gartnavel General Hospital, Glasgow, United Kingdom
| | - Chelliah Paramasivan
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Karl Sylvester
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Fuld
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| |
Collapse
|
33
|
Kang CH, Zhang N, Lott DG. Muscle Tension Dysphagia: Contributing Factors and Treatment Efficacy. Ann Otol Rhinol Laryngol 2020; 130:674-681. [PMID: 33090008 DOI: 10.1177/0003489420966339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine factors contributing to disease etiology and treatment efficacy. STUDY DESIGN Original Report. SETTING Tertiary academic center. METHODS IRB approved prospective study of 20 patients with reported dysphagia who exhibited normal oropharyngeal and esophageal swallowing function as evidenced by videofluoroscopic swallow study, esophagogastroduodenoscopy, high-resolution esophageal manometry with stationary impedance, and Bravo pH probe off proton pump inhibitor. Patients underwent speech-language pathology intervention. RESULTS Atypical laryngeal muscle tension was present in 100% of patients. Forty percent of patients had diagnosed positive gastroesophageal reflux disease. Sixty-five percent of patients showed signs of non-specific laryngeal inflammation and laryngeal hyperresponsiveness during strobolaryngoscopy. All patients reported a mean of 90% recovery by the completion of voice therapy directed toward unloading muscle tension. CONCLUSION The study results suggest an association between laryngeal muscle tension and these patients' dysphagia symptoms regardless of associated conditions. Speech-language pathology intervention showed high treatment efficacy. LEVEL OF EVIDENCE 2c- Outcomes research.
Collapse
Affiliation(s)
- Christina H Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nan Zhang
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
34
|
Haines J, Esposito K, Slinger C, Pargeter N, Murphy J, Selby J, Prior K, Mansur A, Vyas A, Stanton AE, Sabroe I, Hull JH, Fowler SJ. UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID-19 pandemic. Clin Exp Allergy 2020; 50:1287-1293. [PMID: 33034142 PMCID: PMC7675451 DOI: 10.1111/cea.13745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
Prior to the COVID‐19 pandemic, laryngoscopy was the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, upper airway endoscopy is considered an aerosol‐generating procedure in professional guidelines, meaning routine procedures are highly challenging and the availability of laryngoscopy is reduced. In response, we have convened a multidisciplinary panel with broad experience in managing this disease and agreed a recommended strategy for presumptive diagnosis in patients who cannot have laryngoscopy performed due to pandemic restrictions. To maintain clinical standards whilst ensuring patient safety, we discuss the importance of triage, information gathering, symptom assessment and early review of response to treatment. The consensus recommendations will also be potentially relevant to other future situations where access to laryngoscopy is restricted, although we emphasize that this investigation remains the gold standard.
Collapse
Affiliation(s)
- Jemma Haines
- Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Karen Esposito
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Claire Slinger
- Lancashire Chest Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Nicola Pargeter
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | | | - Kathryn Prior
- Lancashire Chest Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Adel Mansur
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Aashish Vyas
- Lancashire Chest Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Ian Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James H Hull
- Royal Brompton Hospital, London, UK.,Institute of Sport, Exercise and Health, University College London, London, UK.,English Institute of Sport, London, UK
| | - Stephen J Fowler
- Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
35
|
Sails J, Hull JH, Allen H, Darville L, Walsted ES, Price OJ. High prevalence of exercise-induced stridor during Parkrun: a cross-sectional field-based evaluation. BMJ Open Respir Res 2020; 7:7/1/e000618. [PMID: 32998911 PMCID: PMC7528425 DOI: 10.1136/bmjresp-2020-000618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/31/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The differential diagnosis for exercise-associated breathlessness is broad, however, when a young athletic individual presents with respiratory symptoms, they are most often prescribed inhaler therapy for presumed exercise-induced asthma (EIA). The purpose of this study was therefore to use a novel sound-based approach to assessment to evaluate the prevalence of exertional respiratory symptoms and characterise abnormal breathing sounds in a large cohort of recreationally active individuals. METHODS Cross-sectional field-based evaluation of individuals completing Parkrun. PHASE 1: Prerace, clinical assessment and baseline spirometry were conducted. At peak exercise and immediately postrace, breathing was monitored continuously using a smartphone. Recordings were analysed retrospectively and coded for signs of the predominant respiratory noise. PHASE 2: A subpopulation that reported symptoms with at least one audible sign of respiratory dysfunction was randomly selected and invited to attend the laboratory on a separate occasion to undergo objective clinical workup to confirm or refute EIA. RESULTS Forty-eight participants (22.6%) had at least one audible sign of respiratory dysfunction; inspiratory stridor (9.9%), expiratory wheeze (3.3%), combined stridor+wheeze (3.3%), cough (6.1%). Over one-third of the cohort (38.2%) were classified as symptomatic. Ten individuals attended a follow-up appointment, however, only one had objective evidence of EIA. CONCLUSIONS The most common audible sign, detected in approximately 1 in 10 individuals, was inspiratory stridor, a characteristic feature of upper airway closure occurring during exercise. Further work is now required to further validate the precision and feasibility of this diagnostic approach in cohorts reporting exertional breathing difficulty.
Collapse
Affiliation(s)
- Joe Sails
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Hayden Allen
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Liam Darville
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Emil S Walsted
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Oliver J Price
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK .,Leeds Institute of Medical Research at St. James', University of Leeds, Leeds, UK
| |
Collapse
|
36
|
Dempsey JA, La Gerche A, Hull JH. Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise? J Appl Physiol (1985) 2020; 129:1235-1256. [PMID: 32790594 DOI: 10.1152/japplphysiol.00444.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the healthy, untrained young adult, a case is made for a respiratory system (airways, pulmonary vasculature, lung parenchyma, respiratory muscles, and neural ventilatory control system) that is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider circumstances in which the intra/extrathoracic airways, pulmonary vasculature, respiratory muscles, and/or blood-gas distribution are underbuilt or inadequately regulated relative to the demands imposed by the cardiovascular system. In these instances, the respiratory system presents a significant limitation to O2 transport and contributes to the occurrence of locomotor muscle fatigue, inhibition of central locomotor output, and exercise performance. Most prominent in these examples of an "underbuilt" respiratory system are highly trained endurance athletes, with additional influences of sex, aging, hypoxic environments, and the highly inbred equine. We summarize by evaluating the relative influences of these respiratory system limitations on exercise performance and their impact on pathophysiology and provide recommendations for future investigation.
Collapse
Affiliation(s)
- Jerome A Dempsey
- John Robert Sutton Professor of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.,National Center for Sports Cardiology, St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Institute of Sport, Exercise and Health (ISEH), University College London, United Kingdom
| |
Collapse
|
37
|
|
38
|
Lee JH, An J, Won HK, Kang Y, Kwon HS, Kim TB, Cho YS, Moon HB, Song WJ, Hull JH. Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis. J Allergy Clin Immunol 2020; 145:1165-1173. [PMID: 31940470 DOI: 10.1016/j.jaci.2019.12.906] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/15/2019] [Accepted: 12/30/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal or vocal cord dysfunction has long been regarded as a mimic of asthma; however, recent evidence indicates that it may be a significant comorbid condition in patients with asthma. OBJECTIVE We aimed to systematically estimate the prevalence of comorbid laryngeal dysfunction (LD) in adults with asthma and characterize its clinical impact on asthma. METHODS Electronic databases were searched for relevant studies published until June 2019. Studies were included if LD was objectively defined by direct visualization of laryngeal movement. Outcomes included the prevalence of LD and its association with clinical asthma indicators, such as severity, control, and quality of life. Random effects meta-analyses were performed to calculate the estimates. RESULTS A total of 21 studies involving 1637 patients were identified. Overall, the pooled prevalence of LD in adults with asthma was 25% (95% CI = 15%-37%; I2 = 96%). Prevalence estimates differed according to the diagnostic test utilized, with the lowest overall prevalence (4% [95% CI = 0%-10%; I2 = 90%]) seen when LD was diagnosed by resting laryngoscopy without external stimuli; however, it was much higher when diagnosed by laryngoscopy studies utilizing an external trigger, such as exercise (38% [95% CI = 24%-53%; I2 = 90%]) or in studies using a computed tomography-based diagnostic protocol (36% [95% CI = 24%-49%; I2 = 78%]). Only 7 studies reported the associations between LD and clinical asthma indicators; inconsistencies between studies limited meaningful conclusions. CONCLUSION LD may be a common comorbidity in asthma, affecting about 25% of adult patients. Further prospective studies are needed to better characterize its clinical impact and the benefits of detecting and managing LD in patients with asthma.
Collapse
Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Yewon Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - James H Hull
- National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
39
|
Lee J, Denton E, Hoy R, Tay TR, Bondarenko J, Hore-Lacy F, Radhakrishna N, O'Hehir RE, Dabscheck E, Abramson MJ, Hew M. Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2256-2262. [PMID: 32173506 DOI: 10.1016/j.jaip.2020.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/13/2020] [Accepted: 02/23/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients with difficult asthma also have coexisting vocal cord dysfunction (VCD), evident by paradoxical vocal fold motion (PVFM) on laryngoscopy. OBJECTIVE Among patients with difficult asthma, we sought to identify clinical features associated with laryngoscopy-diagnosed PVFM. METHODS Consecutive patients with "difficult asthma" referred by respiratory specialists underwent systematic assessment in this observational study. Those with a high clinical suspicion for VCD were referred for laryngoscopy, either at rest or after mannitol provocation. Statistical analyses were performed to identify clinical factors associated with PVFM, and a multivariate logistic regression model was fitted to control for confounders. RESULTS Of 169 patients with difficult asthma, 63 (37.3%) had a high clinical probability of VCD. Of 42 who underwent laryngoscopy, 32 had PVFM confirmed. Patients with PVFM more likely had preserved lung function (prebronchodilator forced expiratory ratio 74% ± 11 vs 62% ± 16, P < .001); physiotherapist-confirmed dysfunctional breathing (odds ratio [OR] = 5.52, 95% confidence interval [CI]: 2.4-12.7, P < .001), gastro-oesophageal reflux (OR = 2.6, 95% CI: 1.16-5.8, P = .02), and a lower peripheral eosinophil count (0.09 vs 0.23, P = .004). On multivariate logistic regression, independent predictors for PVFM were dysfunctional breathing (OR = 4.93, 95% CI: 2-12, P < .001) and preserved lung function (OR = 1.07, 95% CI: 1.028-1.106, P < .001). CONCLUSION Among specialist-referred patients with difficult asthma, VCD pathogenesis may overlap with dysfunctional breathing but is not associated with severe airflow obstruction. Dysfunctional breathing and preserved lung function may serve as clinical clues for the presence of VCD.
Collapse
Affiliation(s)
- Joy Lee
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ryan Hoy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tunn Ren Tay
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore
| | - Janet Bondarenko
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Respiratory Medicine, Allergy and Clinical Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael J Abramson
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
40
|
Leong P, Ruane LE, Phyland D, Koh J, MacDonald MI, Baxter M, Lau KK, Hamza K, Bardin PG. Inspiratory vocal cord closure in COPD. Eur Respir J 2020; 55:13993003.01466-2019. [DOI: 10.1183/13993003.01466-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/22/2020] [Indexed: 11/05/2022]
|
41
|
Barker N, Thevasagayam R, Ugonna K, Kirkby J. Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management. Front Pediatr 2020; 8:379. [PMID: 32766182 PMCID: PMC7378385 DOI: 10.3389/fped.2020.00379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Dysfunctional breathing (DB) is an overarching term describing deviations in the normal biomechanical patterns of breathing which have a significant impact on quality of life, performance and functioning. Whilst it occurs in both children and adults, this article focuses specifically on children. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO). They can be considered in isolation, however, are intricately related and often co-exist. When both are suspected, we propose both BPD and ILO be investigated within an all-encompassing multi-disciplinary dysfunctional breathing clinic. The MDT clinic can diagnose DB through expert history taking and a choice of appropriate tests/examinations which may include spirometry, breathing pattern analysis, exercise testing and laryngoscopic examination. Use of the proposed algorithm presented in this article will aid decision making regarding choosing the most appropriate tests and understanding the diagnostic implications of these tests. The most common symptoms of DB are shortness of breath and chest discomfort, often during exercise. Patients with DB typically present with normal spirometry and an altered breathing pattern at rest which is amplified during exercise. In pediatric ILO, abnormalities of the upper airway such as cobblestoning are commonly seen followed by abnormal activity of the upper airway structures provoked by exercise. This may be associated with a varying degree of stridor. The symptoms, however, are often misdiagnosed as asthma and the picture can be further complicated by the common co-presentation of DB and asthma. Associated conditions such as asthma, extra-esophageal reflux, rhinitis, and allergy must be treated appropriately and well controlled before any directed therapy for DB can be started if therapy is to be successful. DB in pediatrics is commonly treated with a course of non-pharmaceutical therapy. The therapy is provided by an experienced physiotherapist, speech and language therapist or psychologist depending on the dominant features of the DB presentation (i.e., BPD or ILO in combination or in isolation) and some patients will benefit from input from more than one of these disciplines. An individualized treatment program based on expert assessment and personalized goals will result in a return to normal function with reoccurrence being rare.
Collapse
Affiliation(s)
- Nicki Barker
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Ravi Thevasagayam
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Kirkby
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| |
Collapse
|
42
|
Allen KJ, Hull JH. Active or passive laryngeal closure. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. J. Allen
- Equine Hospital Bristol Vet School University of Bristol LangfordUK
| | - J. H. Hull
- Department of Respiratory Medicine Respiratory Biomedical Research Unit Royal Brompton and Harefield National Health Service Foundation Trust London UK
| |
Collapse
|
43
|
Song WJ. Laryngeal Dysfunction in Chronic Cough: A Sign for Specific Cough Endotype? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:2096-2097. [PMID: 30390907 DOI: 10.1016/j.jaip.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
44
|
Petrov AA. Vocal Cord Dysfunction: The Spectrum Across the Ages. Immunol Allergy Clin North Am 2019; 39:547-560. [PMID: 31563188 DOI: 10.1016/j.iac.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vocal cord dysfunction (VCD) is an upper airway disorder characterized by exaggerated and transient glottic constriction causing respiratory and laryngeal symptoms. Although the origin of VCD symptoms is in the upper airway, it is frequently misdiagnosed as asthma resulting in significant morbidity. VCD can coexist with asthma or mimic allergic conditions affecting the upper airway. VCD may be difficult to diagnose, because patients are intermittently symptomatic and VCD awareness in the medical community is underappreciated. Once VCD is diagnosed and treated, most patients report significant improvement in their symptoms as well as a decrease in asthma medication use.
Collapse
Affiliation(s)
- Andrej A Petrov
- Section of Allergy, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
45
|
Understanding the total airway response to exercise: current perspectives and future challenges. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
46
|
Slinger C, Mehdi SB, Milan SJ, Dodd S, Matthews J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Cochrane Database Syst Rev 2019; 7:CD013067. [PMID: 31335963 PMCID: PMC6649889 DOI: 10.1002/14651858.cd013067.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cough both protects and clears the airway. Cough has three phases: breathing in (inspiration), closure of the glottis, and a forced expiratory effort. Chronic cough has a negative, far-reaching impact on quality of life. Few effective medical treatments for individuals with unexplained (idiopathic/refractory) chronic cough (UCC) are known. For this group, current guidelines advocate the use of gabapentin. Speech and language therapy (SLT) has been considered as a non-pharmacological option for managing UCC without the risks and side effects associated with pharmacological agents, and this review considers the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of SLT in this context. OBJECTIVES To evaluate the effectiveness of speech and language therapy for treatment of people with unexplained (idiopathic/refractory) chronic cough. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, trials registries, and reference lists of included studies. Our most recent search was 8 February 2019. SELECTION CRITERIA We included RCTs in which participants had a diagnosis of UCC having undergone a full diagnostic workup to exclude an underlying cause, as per published guidelines or local protocols, and where the intervention included speech and language therapy techniques for UCC. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of 94 records. Two clinical trials, represented in 10 study reports, met our predefined inclusion criteria. Two review authors independently assessed risk of bias for each study and extracted outcome data. We analysed dichotomous data as odds ratios (ORs), and continuous data as mean differences (MDs) or geometric mean differences. We used standard methods recommended by Cochrane. Our primary outcomes were health-related quality of life (HRQoL) and serious adverse events (SAEs). MAIN RESULTS We found two studies involving 162 adults that met our inclusion criteria. Neither of the two studies included children. The duration of treatment and length of sessions varied between studies from four sessions delivered weekly, to four sessions over two months. Similarly, length of sessions varied slightly from one 60-minute session and three 45-minute sessions to four 30-minute sessions. The control interventions were healthy lifestyle advice in both studies.One study contributed HRQoL data, using the Leicester Cough Questionnaire (LCQ), and we judged the quality of the evidence to be low using the GRADE approach. Data were reported as between-group difference from baseline to four weeks (MD 1.53, 95% confidence interval (CI) 0.21 to 2.85; participants = 71), revealing a statistically significant benefit for people receiving a physiotherapy and speech and language therapy intervention (PSALTI) versus control. However, the difference between PSALTI and control was not observed between week four and three months. The same study provided information on SAEs, and there were no SAEs in either the PSALTI or control arms. Using the GRADE approach we judged the quality of evidence for this outcome to be low.Data were also available for our prespecified secondary outcomes. In each case data were provided by only one study, therefore there were no opportunities for aggregation; we judged the quality of this evidence to be low for each outcome. A significant difference favouring therapy was demonstrated for: objective cough counts (ratio for mean coughs per hour on treatment was 59% (95% CI 37% to 95%) relative to control; participants = 71); symptom score (MD 9.80, 95% CI 4.50 to 15.10; participants = 87); and clinical improvement as defined by trialists (OR 48.13, 95% CI 13.53 to 171.25; participants = 87). There was no significant difference between therapy and control regarding subjective measures of cough (MD on visual analogue scale of cough severity: -9.72, 95% CI -20.80 to 1.36; participants = 71) and cough reflex sensitivity (capsaicin concentration to induce five coughs: 1.11 (95% CI 0.80 to 1.54; participants = 49) times higher on treatment than on control). One study reported data on adverse events, and there were no adverse events reported in either the therapy or control arms of the study. AUTHORS' CONCLUSIONS The paucity of data in this review highlights the need for more controlled trial data examining the efficacy of SLT interventions in the management of UCC. Although a large number of studies were found in the initial search as per protocol, we could include only two studies in the review. In addition, this review highlights that endpoints vary between published studies.The improvements in HRQoL (LCQ) and reduction in 24-hour cough frequency seen with the PSALTI intervention were statistically significant but short-lived, with the between-group difference lasting up to four weeks only. Further studies are required to replicate these findings and to investigate the effects of SLT interventions over time. It is clear that SLT interventions vary between studies. Further research is needed to understand which aspects of SLT interventions are most effective in reducing cough (both objective cough frequency and subjective measures of cough) and improving HRQoL. We consider these endpoints to be clinically important. It is also important for future studies to report information on adverse events.Because of the paucity of data, we can draw no robust conclusions regarding the efficacy of SLT interventions for improving outcomes in unexplained chronic cough. Our review identifies the need for further high-quality research, with comparable endpoints to inform robust conclusions.
Collapse
Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | | | - Steven Dodd
- Lancaster UniversityFaculty of Health and MedicineLancasterUK
| | - Jessica Matthews
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Aashish Vyas
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Paul A Marsden
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
- Wythenshawe Hospital, Manchester University NHS Foundation TrustNorth West Lung CentreManchesterUK
- School of Biological Sciences, University of ManchesterDivision of Infection, Immunity and Respiratory MedicineManchesterUK
| | | |
Collapse
|
47
|
Famokunwa B, Walsted ES, Hull JH. Assessing laryngeal function and hypersensitivity. Pulm Pharmacol Ther 2019; 56:108-115. [PMID: 31004747 DOI: 10.1016/j.pupt.2019.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
The larynx is one of the most highly innervated organs in humans, adapted to simultaneously deliver several key respiratory functions including airway protection, swallowing and phonation. In some individuals the larynx can adopt a state that could be considered 'dysfunctional' or maladaptive; resulting in or contributing to a range of clinical disorders such as chronic refractory cough, inducible laryngeal obstruction (previously termed paradoxical vocal fold movement or vocal cord dysfunction), muscle tension dysphonia and globus pharyngeus. These disorders appear to display significant overlap in clinical symptomology and in many cases have features of concomitant or allied sensory dysfunction; often described as laryngeal hypersensitivity. The recognition and accurate assessment of both laryngeal dysfunction±hypersensitivity is important to ensure accurate diagnosis and effective delivery of targeted treatment and therapeutic monitoring. Accordingly, there is increasing in the methodologies proposed to assess laryngeal function. These range from simple questionnaires to targeted investigation(s), assessing both sensory function and the laryngeal motor response, under both resting and provoked situations. This review provides a brief overview of the current state of knowledge in the field of laryngeal dysfunction and hypersensitivity assessment.
Collapse
Affiliation(s)
- B Famokunwa
- Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - E S Walsted
- Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark; Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6HP, UK
| | - J H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6HP, UK.
| |
Collapse
|
48
|
Hull JH. Multidisciplinary team working for vocal cord dysfunction: Now it's GO time. Respirology 2019; 24:714-715. [PMID: 30977222 DOI: 10.1111/resp.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022]
Affiliation(s)
- James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| |
Collapse
|
49
|
Lin J, Walsted ES, Backer V, Hull JH, Elson DS. Quantification and Analysis of Laryngeal Closure From Endoscopic Videos. IEEE Trans Biomed Eng 2019; 66:1127-1136. [DOI: 10.1109/tbme.2018.2867636] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
50
|
Vertigan AE, Haines J, Slovarp L. An Update on Speech Pathology Management of Chronic Refractory Cough. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1756-1761. [PMID: 30940533 DOI: 10.1016/j.jaip.2019.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/28/2022]
Abstract
Chronic cough is a common, debilitating condition that can persist for years with little relief from medical treatment. Speech pathology treatment is an effective treatment option for patients with chronic cough. This review outlines current speech pathology assessment and treatment for chronic cough and describes the evidence supporting the intervention. The rationale for speech pathology intervention is described with reference to speech pathology training and expertise that are relevant for this condition. Despite the efficacy and advantages of speech pathology intervention, there is limited guidance in the literature on when patients should be referred for treatment. Patients suitable for speech pathology intervention are those whose cough has persisted despite medical management. Speech pathology intervention may be particularly beneficial for patients with coexisting laryngeal disorders such as muscle tension dysphonia or inducible laryngeal obstruction. Limited information is available regarding current speech pathology training, practice, and service delivery for chronic cough internationally. Timely referral for speech pathology intervention could reduce the disease burden for individuals with chronic cough and decrease the economic burden of this complex condition.
Collapse
Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, New Lambton Heights, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Jemma Haines
- North West Lung Centre, Manchester University NHS Foundation Trust Wythenshawe Hospital, Manchester, United Kingdom
| | - Laurie Slovarp
- Speech, Language, Hearing Sciences Department, University of Montana, Missoula, Mont
| |
Collapse
|