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Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function.
J Allergy Clin Immunol Pract. 2020 Jul - Aug; 8(7):2256-2262.JA

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.

Authors+Show Affiliations

Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: joy.lee@alfred.org.au.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia.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.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32173506

Citation

Lee, Joy, et al. "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, vol. 8, no. 7, 2020, pp. 2256-2262.
Lee J, Denton E, Hoy R, et al. Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function. J Allergy Clin Immunol Pract. 2020;8(7):2256-2262.
Lee, J., Denton, E., Hoy, R., Tay, T. R., Bondarenko, J., Hore-Lacy, F., Radhakrishna, N., O'Hehir, R. E., Dabscheck, E., Abramson, M. J., & Hew, M. (2020). 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, 8(7), 2256-2262. https://doi.org/10.1016/j.jaip.2020.02.037
Lee J, et al. Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated With Dysfunctional Breathing and Preserved Lung Function. J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2256-2262. PubMed PMID: 32173506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function. AU - Lee,Joy, AU - Denton,Eve, AU - Hoy,Ryan, AU - Tay,Tunn Ren, AU - Bondarenko,Janet, AU - Hore-Lacy,Fiona, AU - Radhakrishna,Naghmeh, AU - O'Hehir,Robyn E, AU - Dabscheck,Eli, AU - Abramson,Michael J, AU - Hew,Mark, Y1 - 2020/03/12/ PY - 2019/09/19/received PY - 2020/01/13/revised PY - 2020/02/23/accepted PY - 2020/3/17/pubmed PY - 2020/3/17/medline PY - 2020/3/17/entrez KW - Asthma KW - Larynx KW - Paradoxical vocal fold motion KW - Vocal cord dysfunction SP - 2256 EP - 2262 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 8 IS - 7 N2 - 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. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/32173506/Paradoxical_Vocal_Fold_Motion_in_Difficult_Asthma_Is_Associated_with_Dysfunctional_Breathing_and_Preserved_Lung_Function L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(20)30238-5 DB - PRIME DP - Unbound Medicine ER -
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