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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
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Majellano EC, Clark VL, Vertigan A, Gibson PG, Bardin P, Leong P, McDonald VM. Living With Asthma and Vocal Cord Dysfunction/Inducible Laryngeal Obstruction: "I Just Can't Get Air In". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1326-1336. [PMID: 38290607 DOI: 10.1016/j.jaip.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Asthma and vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO), may coexist, resulting in worse outcomes for patients. The experience of people with VCD/ILO and coexisting asthma is unknown. OBJECTIVE We sought to determine whether coexistent VCD/ILO and asthma have deleterious impacts on quality of life. METHODS We undertook a descriptive qualitative study using one-to-one semistructured interviews with 30 purposively recruited adult participants with a prior confirmed doctor asthma diagnosis and laryngoscopy-confirmed VCD/ILO. A thematic and content analysis was conducted to explore the data. RESULTS Participants were mostly female (63%), mean ± SD age 63 ± 12 years. Four themes were identified: trapped voice, altered life, knowledge about VCD/ILO, and looking for solutions. Participants reported their voice being trapped in their throat or the voice being suddenly cut off when talking or singing. Self-reported VCD/ILO symptoms including throat tightness and breathlessness were highlighted by participants. The second theme described how patients struggle to communicate or tended to shorten conversations. Insufficient knowledge and existing confusion regarding whether asthma was causing the breathlessness was described in the third theme. Looking for solutions depicted participants' diagnostic journey and how they sought an explanation for the symptoms. CONCLUSIONS People with asthma and coexisting VCD/ILO experience a substantial burden affecting the quality of life. These data describe the impact on patients with coexisting conditions and should be used to increase clinician awareness of the experience of VCD/ILO from patients' perspectives to support a personalized approach to care.
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Affiliation(s)
- Eleanor C Majellano
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anne Vertigan
- National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; Speech Pathology Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Philip Bardin
- Monash Lung, Sleep, Allergy and Immunology, Monash Health and Monash University, Melbourne, Victoria, Australia; School of Clinical Sciences, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung, Sleep, Allergy and Immunology, Monash Health and Monash University, Melbourne, Victoria, Australia; School of Clinical Sciences, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia; National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
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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.
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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
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Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024:S0012-3692(24)00396-9. [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] [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 (CRC) 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 CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC 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.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology & 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
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Leong P, Hull JH, Gibson PG, Halvorsen T, Bardin PG. Reply. J Allergy Clin Immunol 2023; 152:1688-1689. [PMID: 37737751 DOI: 10.1016/j.jaci.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Paul Leong
- Monash Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia.
| | | | - Peter G Gibson
- John Hunter Hospital, Newcastle, Australia; Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia
| | - Thomas Halvorsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway; Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Philip G Bardin
- Monash Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia
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Weinberger M. VCD and ILO are not synonymous. J Allergy Clin Immunol 2023; 152:1687-1688. [PMID: 37737750 DOI: 10.1016/j.jaci.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Miles Weinberger
- University of California San Diego, San Diego, Calif, and Rady Children's Hospital, San Diego, Calif.
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Zhou X, Zhang P, Tan H, Dong B, Jing Z, Wu H, Luo J, Zhang Y, Zhang J, Sun X. Progress in diagnosis and treatment of difficult-to-treat asthma in children. Ther Adv Respir Dis 2023; 17:17534666231213637. [PMID: 38069568 PMCID: PMC10710755 DOI: 10.1177/17534666231213637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
At present, medications containing inhaled corticosteroids (ICS-containing) are the keystones of asthma treatment. The majority of asthmatic children can significantly improve clinical outcomes with little worsening by standardized inhaled glucocorticoid treatment, but there is still a small proportion of children who are unable to achieve good symptom control even after the maximum standardized treatment, known as 'children with difficult-to-treat asthma (DA)'. The high heterogeneity of DA makes therapy challenging and expensive, which poses a serious risk to children's health and makes it extremely difficult for clinical physicians to accurately identify and treat children with DA. This article reviews the definition, evaluation, and treatment of this asthma in order to provide a reference for optimal clinical decision-making.
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Affiliation(s)
- Xuehua Zhou
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Panpan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hong Tan
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Bo Dong
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zenghui Jing
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Huajie Wu
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jianfeng Luo
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yao Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
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