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Diagnosis of concomitant inducible laryngeal obstruction and asthma.
Clin Exp Allergy. 2018 12; 48(12):1622-1630.CE

Abstract

BACKGROUND

Inducible laryngeal obstruction, an induced, inappropriate narrowing of the larynx, leading to symptomatic upper airway obstruction, can coexist with asthma. Accurate classification has been challenging because of overlapping symptoms and the absence of sensitive diagnostic criteria for either condition.

OBJECTIVE

To evaluate patients with concomitant clinical suspicion for inducible laryngeal obstruction and asthma. We used a multidisciplinary protocol incorporating objective diagnostic criteria to determine whether asthma, inducible laryngeal obstruction, both, or neither diagnosis was present.

METHODS

Consecutive patients were prospectively assessed by a laryngologist, speech pathologist and respiratory physician. Inducible laryngeal obstruction was diagnosed by visualizing paradoxical vocal fold motion either at baseline or following mannitol provocation. Asthma was diagnosed by physician assessment with objective variable airflow obstruction. Validated questionnaires for laryngeal dysfunction and relevant comorbidities were administered.

RESULTS

Of 69 patients, 15 had asthma alone, 11 had inducible laryngeal obstruction alone and 14 had neither objectively demonstrated. Twenty-nine patients had both diagnoses. In 19 patients, inducible laryngeal obstruction was only seen following provocation. Among patients with inducible laryngeal obstruction, chest tightness was more frequent with concurrent asthma. Among patients with asthma, stridor was more frequent with concurrent inducible laryngeal obstruction. Cough was more frequently found in asthma alone, whereas difficulty with inspiration and symptoms triggered by psychological stress were more frequently found in inducible laryngeal obstruction alone. Patients with asthma alone had greater airflow obstruction. Relevant comorbidities were frequent (rhinitis in 85%, gastro-oesophageal reflux in 65%), and questionnaire scores for laryngeal dysfunction were abnormal. However, neither comorbidities nor questionnaires differentiated patients with or without inducible laryngeal obstruction.

CONCLUSIONS AND CLINICAL RELEVANCE

In this cohort with suspected inducible laryngeal obstruction and asthma, 42% had objective evidence of both conditions. Clinical assessment, questionnaire scores and comorbidity burden were not sufficiently discriminatory for diagnosis, highlighting the necessity of objective diagnostic testing.

Authors+Show Affiliations

School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Vic., Australia.Department of Respiratory Medicine, Changi General Hospital, Singapore, Singapore.Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Vic., Australia. Department of Surgery, Monash University, Melbourne, Vic., Australia.Department of Otolaryngology, Head and Neck Surgery, The Royal Melbourne Hospital, Melbourne, Vic., Australia.Department of Speech Pathology, The Alfred Hospital, Melbourne, Vic., Australia.Department of Speech Pathology, The Alfred Hospital, Melbourne, Vic., Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Vic., Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Vic., Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29870077

Citation

Lee, Joy W., et al. "Diagnosis of Concomitant Inducible Laryngeal Obstruction and Asthma." Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 48, no. 12, 2018, pp. 1622-1630.
Lee JW, Tay TR, Paddle P, et al. Diagnosis of concomitant inducible laryngeal obstruction and asthma. Clin Exp Allergy. 2018;48(12):1622-1630.
Lee, J. W., Tay, T. R., Paddle, P., Richards, A. L., Pointon, L., Voortman, M., Abramson, M. J., Hoy, R., & Hew, M. (2018). Diagnosis of concomitant inducible laryngeal obstruction and asthma. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 48(12), 1622-1630. https://doi.org/10.1111/cea.13185
Lee JW, et al. Diagnosis of Concomitant Inducible Laryngeal Obstruction and Asthma. Clin Exp Allergy. 2018;48(12):1622-1630. PubMed PMID: 29870077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of concomitant inducible laryngeal obstruction and asthma. AU - Lee,Joy W, AU - Tay,Tunn Ren, AU - Paddle,Paul, AU - Richards,Amanda L, AU - Pointon,Lisa, AU - Voortman,Miriam, AU - Abramson,Michael J, AU - Hoy,Ryan, AU - Hew,Mark, Y1 - 2018/06/27/ PY - 2018/01/15/received PY - 2018/05/09/revised PY - 2018/05/31/accepted PY - 2018/6/6/pubmed PY - 2019/11/15/medline PY - 2018/6/6/entrez KW - asthma KW - inducible laryngeal obstruction KW - larynx KW - mannitol KW - paradoxical vocal fold motion SP - 1622 EP - 1630 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 48 IS - 12 N2 - BACKGROUND: Inducible laryngeal obstruction, an induced, inappropriate narrowing of the larynx, leading to symptomatic upper airway obstruction, can coexist with asthma. Accurate classification has been challenging because of overlapping symptoms and the absence of sensitive diagnostic criteria for either condition. OBJECTIVE: To evaluate patients with concomitant clinical suspicion for inducible laryngeal obstruction and asthma. We used a multidisciplinary protocol incorporating objective diagnostic criteria to determine whether asthma, inducible laryngeal obstruction, both, or neither diagnosis was present. METHODS: Consecutive patients were prospectively assessed by a laryngologist, speech pathologist and respiratory physician. Inducible laryngeal obstruction was diagnosed by visualizing paradoxical vocal fold motion either at baseline or following mannitol provocation. Asthma was diagnosed by physician assessment with objective variable airflow obstruction. Validated questionnaires for laryngeal dysfunction and relevant comorbidities were administered. RESULTS: Of 69 patients, 15 had asthma alone, 11 had inducible laryngeal obstruction alone and 14 had neither objectively demonstrated. Twenty-nine patients had both diagnoses. In 19 patients, inducible laryngeal obstruction was only seen following provocation. Among patients with inducible laryngeal obstruction, chest tightness was more frequent with concurrent asthma. Among patients with asthma, stridor was more frequent with concurrent inducible laryngeal obstruction. Cough was more frequently found in asthma alone, whereas difficulty with inspiration and symptoms triggered by psychological stress were more frequently found in inducible laryngeal obstruction alone. Patients with asthma alone had greater airflow obstruction. Relevant comorbidities were frequent (rhinitis in 85%, gastro-oesophageal reflux in 65%), and questionnaire scores for laryngeal dysfunction were abnormal. However, neither comorbidities nor questionnaires differentiated patients with or without inducible laryngeal obstruction. CONCLUSIONS AND CLINICAL RELEVANCE: In this cohort with suspected inducible laryngeal obstruction and asthma, 42% had objective evidence of both conditions. Clinical assessment, questionnaire scores and comorbidity burden were not sufficiently discriminatory for diagnosis, highlighting the necessity of objective diagnostic testing. SN - 1365-2222 UR - https://www.unboundmedicine.com/medline/citation/29870077/Diagnosis_of_concomitant_inducible_laryngeal_obstruction_and_asthma_ L2 - https://doi.org/10.1111/cea.13185 DB - PRIME DP - Unbound Medicine ER -