Vocal cord dysfunction (VCD) is a respiratory disorder characterized by paradoxical closure of the vocal cords during the respiratory cycle leading to obstructive airway symptoms. The presenting symptoms vary from stridor to wheezing. VCD may coexist with asthma or masquerade as asthma. Misdiagnosis of VCD as asthma leads to inappropriate use of systemic steroids with its adverse effects, frequent emergency department visits, hospitalization, and, rarely, intubation and tracheostomy. Attenuation of the inspiratory flow volume loop on spirometry is suggestive of VCD. Laryngoscopic demonstration of the paradoxical vocal cord movements during an acute attack is the gold standard for the diagnosis of VCD. Patient education, speech therapy, and psychologic counseling are the therapeutic tools for treatment.
This study determined retention by children of drug delivery device technique between visits. Patients had asthma requiring the daily use of at least one medication delivery device. Seventy-two patients completed the study; 24 used only the metered dose inhaler (MDI) (group 1), while 48 used the MDI and 1 other device (group 2). Patients or caregivers were initially instructed on and demonstrated the correct use of their medication delivery device(s). At their next visit, they demonstrated their technique for each device. At follow-up, 36% correctly performed all components of the MDI. Group 1 (50%) was higher than group 2 (29%). The percent of correct MDI components for group 1 (84) was also higher than group 2 (78) but not significantly. For both groups and devices, breathing out before inhalation and breath holding was problematic. This study reinforces the need to demonstrate and observe the correct use of inhalation devices at each clinic visit.
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