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Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis.
J Allergy Clin Immunol. 2020 Apr; 145(4):1165-1173.JA

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.

Authors+Show Affiliations

Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: swj0126@amc.seoul.kr.National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: j.hull@rbht.nhs.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31940470

Citation

Lee, Ji-Hyang, et al. "Prevalence and Impact of Comorbid Laryngeal Dysfunction in Asthma: a Systematic Review and Meta-analysis." The Journal of Allergy and Clinical Immunology, vol. 145, no. 4, 2020, pp. 1165-1173.
Lee JH, An J, Won HK, et al. Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis. J Allergy Clin Immunol. 2020;145(4):1165-1173.
Lee, J. H., An, J., Won, H. K., Kang, Y., Kwon, H. S., Kim, T. B., Cho, Y. S., Moon, H. B., Song, W. J., & Hull, J. H. (2020). Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis. The Journal of Allergy and Clinical Immunology, 145(4), 1165-1173. https://doi.org/10.1016/j.jaci.2019.12.906
Lee JH, et al. Prevalence and Impact of Comorbid Laryngeal Dysfunction in Asthma: a Systematic Review and Meta-analysis. J Allergy Clin Immunol. 2020;145(4):1165-1173. PubMed PMID: 31940470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis. AU - Lee,Ji-Hyang, AU - An,Jin, AU - Won,Ha-Kyeong, AU - Kang,Yewon, AU - Kwon,Hyouk-Soo, AU - Kim,Tae-Bum, AU - Cho,You Sook, AU - Moon,Hee-Bom, AU - Song,Woo-Jung, AU - Hull,James H, Y1 - 2020/01/12/ PY - 2019/09/19/received PY - 2019/12/15/revised PY - 2019/12/30/accepted PY - 2020/1/16/pubmed PY - 2020/1/16/medline PY - 2020/1/16/entrez KW - Laryngeal dysfunction KW - asthma KW - inducible laryngeal obstruction KW - prevalence KW - systematic review KW - treatable traits KW - vocal cord dysfunction SP - 1165 EP - 1173 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 145 IS - 4 N2 - 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. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/31940470/Prevalence_and_impact_of_comorbid_laryngeal_dysfunction_in_asthma:_A_systematic_review_and_meta-analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(20)30028-2 DB - PRIME DP - Unbound Medicine ER -
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