1
|
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. Int J Lang Commun Disord 2024. [PMID: 38227644 DOI: 10.1111/1460-6984.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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
|
2
|
Ludlow S, Daly R, Elsey L, Hope H, Sheehan R, Fowler SJ. Multidisciplinary management of inducible laryngeal obstruction and breathing pattern disorder. Breathe (Sheff) 2023; 19:230088. [PMID: 37830100 PMCID: PMC10567073 DOI: 10.1183/20734735.0088-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023] Open
Abstract
We provide an overview of the assessment and management of inducible laryngeal obstruction and breathing pattern disorder. We highlight the multidisciplinary team members involved and their essential roles within a complex breathlessness service. We discuss treatments initiated by physiotherapy and speech and language therapy, the importance of joint working, and discuss the high incidence of comorbidities and the association with other respiratory disorders. Educational aims Inducible laryngeal obstruction and breathing pattern disorder are common causes of breathlessness.Inducible laryngeal obstruction is an inappropriate, transient, reversible narrowing of the laryngeal area that causes breathlessness and laryngeal symptoms.Breathing pattern disorder is an alteration in the normal biomechanical patterns of breathing that results in intermittent or chronic symptoms, which may be respiratory and/or non-respiratory.People with inducible laryngeal obstruction or breathing pattern disorder often have other comorbidities that will also need addressing.Multidisciplinary assessment and treatment is essential for comprehensive workup and holistic care.Timely assessment and diagnosis can prevent unnecessary medication use and hospital admissions and facilitate effective management of the condition using reassurance, advice, education, breathing retraining and vocal exercises.
Collapse
Affiliation(s)
- Siobhan Ludlow
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Medical Education, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rachel Daly
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lynn Elsey
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen Hope
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Reyenna Sheehan
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stephen J. Fowler
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Chamberlain Mitchell S, Ellis J, Ludlow S, Pandyan A, Birring S. Non-pharmacological interventions for chronic cough: The past, present and future. Pulm Pharmacol Ther 2019; 56:29-38. [DOI: 10.1016/j.pupt.2019.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 12/22/2022]
|
4
|
Chamberlain Mitchell SAF, Garrod R, Clark L, Douiri A, Parker SM, Ellis J, Fowler SJ, Ludlow S, Hull JH, Chung KF, Lee KK, Bellas H, Pandyan A, Birring SS. Physiotherapy, and speech and language therapy intervention for patients with refractory chronic cough: a multicentre randomised control trial. Thorax 2017; 72:129-136. [PMID: 27682331 DOI: 10.1136/thoraxjnl-2016-208843] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physiotherapy, and speech and language therapy are emerging non-pharmacological treatments for refractory chronic cough. We aimed to investigate the efficacy of a physiotherapy, and speech and language therapy intervention (PSALTI) to improve health-related quality of life (HRQoL) and to reduce cough frequency in patients with refractory chronic cough. METHODS In this multicentre randomised controlled trial, patients with refractory chronic cough were randomised to four weekly 1:1 sessions of either PSALTI consisting of education, laryngeal hygiene and hydration, cough suppression techniques, breathing exercises and psychoeducational counselling or control intervention consisting of healthy lifestyle advice. We assessed the change in HRQoL at week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included 24-hour objective cough frequency (Leicester Cough Monitor) and cough reflex sensitivity. The primary analysis used an analysis of covariance adjusted for baseline measurements with the intention-to-treat population. This study was registered at UK Clinical Research Network (UKCRN ID 10678). FINDINGS Between December 2011 and April 2014, we randomly assigned 75 participants who underwent baseline assessment (34 PSALTI and 41 controls). In the observed case analysis, HRQoL (LCQ) improved on average by 1.53 (95% CI 0.21 to 2.85) points more in PSALTI group than with control (p=0.024). Cough frequency decreased by 41% (95% CI 36% to 95%) in PSALTI group relative to control (p=0.030). The improvements within the PSALTI group were sustained up to 3 months. There was no significant difference between groups in the concentration of capsaicin causing five or more coughs. INTERPRETATION Greater improvements in HRQoL and cough frequency were observed with PSALTI intervention. Our findings support the use of PSALTI for patients with refractory chronic cough. TRIAL REGISTRATION NUMBER UKCRN ID 10678 and ISRCTN 73039760; Results.
Collapse
Affiliation(s)
- Sarah A F Chamberlain Mitchell
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
- School of Health and Rehabilitation, Keele University, Keele, UK
| | - Rachel Garrod
- King's College London, Denmark Hill Campus, London, UK
| | - Lynne Clark
- Speech and Language Therapy Department, King's College Hospital, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- NIHR Biomedical Centre, King's College London, London, UK
| | - Sean M Parker
- Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK
| | - Jenny Ellis
- Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK
| | - Stephen J Fowler
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, The University of Manchester and Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Siobhan Ludlow
- Speech and Language Therapy Department, Leighton Hospital, Mid Cheshire Hospitals Trust, Leighton, UK
| | - James H Hull
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK
| | - Kian Fan Chung
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK
| | - Kai K Lee
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - H Bellas
- Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University, Keele, UK
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| |
Collapse
|
5
|
Shannon K, Pasikhova Y, Ibekweh Q, Ludlow S, Baluch A. Nocardiosis following hematopoietic stem cell transplantation. Transpl Infect Dis 2016; 18:169-75. [PMID: 26809666 DOI: 10.1111/tid.12499] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/29/2015] [Accepted: 11/07/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Nocardia species are ubiquitous environmental organisms that can cause a diverse spectrum of disease. Clinical manifestations range from localized skin and soft tissue infections to life-threatening pulmonary, central nervous system, and/or disseminated infections. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) are at risk for nocardiosis, and further data in regard to characteristics of disease in this population are warranted. METHODS We performed retrospective chart review of patients post allogeneic HSCT at Moffitt Cancer Center in Florida diagnosed with nocardiosis from 2003 to 2013. RESULTS In a decade, 15 cases of nocardiosis were identified. The majority of patients were men (11/15). The median age was 55 years (range 25-65). The most common type of transplant was matched-related donor (n = 8), followed by matched-unrelated donor (n = 3), mismatched-unrelated donor (n = 3), and double umbilical cord (n = 1). Ten received myeloablative conditioning (MAC) regimens. Twelve of 15 patients were on prednisone, 10 of which were on a total daily dose ≥20 mg. The median time from transplant to first positive culture was 10 months (range 1.5-93). Pulmonary nocardiosis was the most prevalent manifestation at 87%. Disseminated disease (2 or more sites of infection) was seen in 47%, whereas blood cultures were positive in 27% of the total cohort. The most common species was Nocardia nova (n = 4). At the time of diagnosis, 20% of the patients were receiving prophylaxis for Pneumocystis jirovecii pneumonia (PJP) with trimethoprim-sulfamethoxazole (TMP-SMX). Susceptibility data were available for 8 patients: all 8 samples were susceptible to TMP-SMX. Nocardiosis was treated with 2 or more active drugs in 93% of the patients. Overall mortality was 53%, with nocardiosis attributed as the cause in 62.5% (5/8). The absolute lymphocyte count at time of diagnoses was significantly lower in patients who ultimately experienced treatment failure. CONCLUSION Infection with Nocardia species in allogeneic HSCT recipients appears to be a late complication of transplantation and most commonly involves the lung. Two-thirds of the cohort received a MAC regimen and the majority of the patients were receiving steroids at the time of diagnosis. Most patients were not receiving TMP-SMX for PJP prophylaxis at the time of nocardiosis diagnosis, and TMP-SMX may therefore have a protective effect.
Collapse
Affiliation(s)
- K Shannon
- Department of Pharmacy, Morton Plant Hospital, BayCare Health System, Clearwater, Florida, USA
| | - Y Pasikhova
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Q Ibekweh
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - S Ludlow
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - A Baluch
- Department of Infectious Diseases, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| |
Collapse
|
6
|
Visser WH, Ferrari MD, Bayliss EM, Ludlow S, Pilgrim AJ. Treatment of migraine attacks with subcutaneous sumatriptan: first placebo-controlled study. The Subcutaneous Sumatriptan International Study Group. Cephalalgia 1992; 12:308-13. [PMID: 1330318 DOI: 10.1046/j.1468-2982.1992.1205308.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The results of the very first large-scale placebo-controlled dose-response trial with the novel selective 5-hydroxytryptamine1-like (5HT1-like) receptor agonist sumatriptan are presented. We studied the efficacy and tolerability of subcutaneous injections of 1 mg, 2 mg and 3 mg of sumatriptan in alleviating migraine attacks in a double-blind, placebo-controlled, parallel-group, multicentre clinical trial. Six-hundred and ninety patients were randomized and 685 received study medication. At 30 min, reduction of headache severity to mild or none (primary efficacy endpoint) was achieved in 22% (95% CI: 15-28%) of placebo-treated patients and in 39% (CI: 31-46%) of patients treated with 1 mg sumatriptan, 44% (CI: 36-51%) treated with 2 mg sumatriptan and 55% (CI: 48-63%) treated with 3 mg sumatriptan. Differences from placebo were 17% (CI: 8-27%) for 1 mg sumatriptan, 22% (CI: 13-32%) for 2 mg sumatriptan and 34% (CI: 24-44%) for 3 mg sumatriptan (p < 0.001 for all three comparisons). Other migraine symptoms were also more effectively treated by sumatriptan than by placebo. Subsequently, an open-label 3 mg dose subcutaneous sumatriptan was given to partial or non-responders. Thirty minutes after this open dose the response rate to sumatriptan had improved to between 70 and 80%. Adverse events after sumatriptan were minor and short-lived. We conclude that subcutaneous sumatriptan is well tolerated in doses up to 3 + 3 mg and may rapidly abort migraine attacks.
Collapse
Affiliation(s)
- W H Visser
- Department of Neurology, University Hospital Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
7
|
|