Laryngoscopy diagnosis of inducible laryngeal obstruction during supervised challenge for suspected anaphylaxis

Stojanovic, Stephanie; Zubrinich, Celia; Sverrild, Asger; Mahoney, Janine; Denton, Eve; Lee, Joy; Hew, Mark

doi:10.1111/cea.14156

Cited by 2 publications

(7 citation statements)

References 9 publications

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“…Roundtable participants emphasized that swift and accurate diagnosis is essential to prevent misdiagnoses, particularly severe asthma with attendant risks of repeated oral corticosteroids, and on occasion, endotracheal intubation 39 . Other patients may be mislabelled as ‘anaphylactic’, resulting in inappropriate adrenaline use, emergency presentations and unwarranted avoidance of suspected drugs or foods 5,6 . However, expeditious diagnosis is often not achieved, and ongoing education is essential to make health care professionals and providers aware of the condition.…”

Section: Assessment and Diagnosismentioning

confidence: 99%

“…Incident-associated VCD/ILO. 5,6,31 Cough-associated VCD/ILO probably represents another group. 11,32 Phenotyping was regarded as a promising approach to heterogeneity and complexity.…”

Section: Assessment and Diagnosismentioning

confidence: 99%

“… 18 At least four distinct clinical phenotypes may be recognized: Classic VCD/ILO (e.g., Kent's seminal description 29 ), Lung‐disease associated VCD/ILO, 7 , 28 , 30 Exercise‐ILO (EILO), 14 Incident‐associated VCD/ILO. 5 , 6 , 31 Cough‐associated VCD/ILO probably represents another group. 11 , 32 …”

Section: Assessment and Diagnosismentioning

confidence: 99%

“…Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) refers to breathlessness in association with inappropriate laryngeal closure. Clinical presentations are heterogenous, occurring in numerous and diverse clinical settings 1–10 . VCD/ILO can be a sole presenting disorder, a mimic of other disorders including seemingly refractory asthma or act as a multimorbidity with asthma or chronic obstructive pulmonary disease (COPD) 10 .…”

Section: Introductionmentioning

confidence: 99%

“…Clinical presentations are heterogenous, occurring in numerous and diverse clinical settings. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 VCD/ILO can be a sole presenting disorder, a mimic of other disorders including seemingly refractory asthma or act as a multimorbidity with asthma or chronic obstructive pulmonary disease (COPD). 10 The coexists in up to 50% of some diseases such as asthma 11 and chronic cough, 11 can have a profound clinical impact, and has been identified as a national and international clinical and research priority.…”

Section: Introductionmentioning

confidence: 99%

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Vocal cord dysfunction/inducible laryngeal obstruction—2022 Melbourne Roundtable Report

et al. 2023

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Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi‐factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence‐based standard of care since randomized trials for treatment are non‐existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.

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Section: Assessment and Diagnosismentioning

confidence: 99%

“…Incident-associated VCD/ILO. 5,6,31 Cough-associated VCD/ILO probably represents another group. 11,32 Phenotyping was regarded as a promising approach to heterogeneity and complexity.…”

Section: Assessment and Diagnosismentioning

confidence: 99%