Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

Hull, James H.; Walsted, Emil Schwarz; Feary, Johanna; Cullinan, Paul; Scadding, Guy; Bailey, Emma; Selby, Julia

doi:10.1002/lary.27620

Cited by 19 publications

(8 citation statements)

References 20 publications

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“…In contrast, challenge laryngoscopy (using external triggers such as exercise or other environmental triggers) is considered to be more valid, although there is still no accepted international consensus guidance on how to perform the challenge testing or exposure protocol. 10 Recently, Hull et al described a continuous laryngoscopy during provocation protocol, 43 but the degree of exposure and outcome measures are yet to be agreed on.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis

Lee

Won

et al. 2020

Journal of Allergy and Clinical Immunology

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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 5 15%-37%; I 2 5 96%). Prevalence estimates differed according to the diagnostic test utilized, with the lowest overall prevalence (4% [95% CI 5 0%-10%; I 2 5 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 5 24%-53%; I 2 5 90%]) or in studies using a computed tomography-based diagnostic protocol (36% [95% CI 5 24%-49%; I 2 5 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.

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Section: Discussionmentioning

confidence: 99%

Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis

Lee

Won

et al. 2020

Journal of Allergy and Clinical Immunology

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“…Flexible fibreoptic laryngoscopy during a symptomatic episode is the gold standard for ILO diagnosis 4,11 . As the upper airway will often appear functionally normal outside of an ILO episode, continuous laryngoscopy during provocation (ie a trigger known to induce ILO symptoms such as inhaled irritants) is often performed 12 …”

Section: Introductionmentioning

confidence: 99%

UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID‐19 pandemic

Haines

Esposito

Slinger

et al. 2020

Clin Experimental Allergy

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Prior to the COVID‐19 pandemic, laryngoscopy was the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, upper airway endoscopy is considered an aerosol‐generating procedure in professional guidelines, meaning routine procedures are highly challenging and the availability of laryngoscopy is reduced. In response, we have convened a multidisciplinary panel with broad experience in managing this disease and agreed a recommended strategy for presumptive diagnosis in patients who cannot have laryngoscopy performed due to pandemic restrictions. To maintain clinical standards whilst ensuring patient safety, we discuss the importance of triage, information gathering, symptom assessment and early review of response to treatment. The consensus recommendations will also be potentially relevant to other future situations where access to laryngoscopy is restricted, although we emphasize that this investigation remains the gold standard.

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“…Establishing a secure diagnosis of laryngeal dysfunction is key step in facilitating the initiation of appropriate treatment and de-escalating inappropriate treatment [13]. Laryngeal examination needs to be performed under “provoked” conditions, as examination in the resting clinical state is not sufficiently informative when investigating these symptoms and exercise or odour/perfume [14] exposure are key and relevant triggers or inducers.…”

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confidence: 99%

Feasibility of portable continuous laryngoscopy during exercise testing

Hull¹,

Walsted²,

Orton³

et al. 2019

ERJ Open Res

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Exercise-induced laryngeal obstruction (EILO) is a prevalent and yet still under-recognised cause of exertional breathlessness [1]. The transient closure of the larynx, which develops during EILO, results in dyspnoea, cough, inspiratory wheeze (i.e. stridor) and tightness in the throat on physical exertion. It is estimated that EILO is present in 6% of adolescents and as many as one in four athletes with unexplained respiratory symptoms [1, 2]. Despite improved recognition over the past 5 years [3, 4], it remains frequently misdiagnosed and mistreated as asthma [2, 5].

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Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

Cited by 19 publications

References 20 publications

Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis

Prevalence and impact of comorbid laryngeal dysfunction in asthma: A systematic review and meta-analysis

UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID‐19 pandemic

Feasibility of portable continuous laryngoscopy during exercise testing

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