Reduced Asthma Medication Use after Treatment of Pediatric Paradoxical Vocal Fold Motion Disorder

Abstract

Objectives/Hypotheses: The primary objective of this study was to determine whether the diagnosis and treatment of pediatric Paradoxical Vocal Fold Motion Disorder (PVFMD) leads to decreased asthma medication use. Our secondary objective was to determine dyspnea outcomes following diagnosis and treatment for PVFMD.Study Design: Prospective observational study. Methods: Patients with newly diagnosed PVFMD between the ages of 11 and 17 were recruited at a single pediatric institution. A medication questionnaire and Dyspnea Index (DI) were completed at the initial visit, at the first return visit, and at greater than 6 months post-diagnosis and therapy. Laryngeal Control Therapy (LCT) consisted of teaching breathing techniques and identifying emotional, physical, and environmental contributing factors and strategies to reduce them.Results: Twenty-six patients were recruited to the study. There were 19/26 (73%) patients diagnosed with asthma prior to a diagnosis of PVFMD, and 26/26 (100%) patients were using an inhaler prior to the enrollment visit. Twenty-two (85%) patients completed follow-up questionnaires. Five patients participated in no therapy, seven patients in partial therapy, and 14 patients in full therapy. Significant reduction in asthma medication use was seen in the full therapy group (P < .05) and in those with exercise as their only trigger (P < .05). Furthermore, symptoms as scored by the DI decreased overall from 25.5 to 18.8 (P < .001).Conclusions: Diagnosis and treatment of pediatric PVFMD leads to a decline in asthma medication use in those patients who participate in at least two LCT sessions and in those with exercise-induced PVFMD. LCT for pediatric PVFMD leads to a significant decrease in symptoms as measured by the DI.

The impact of identifying laryngeal obstruction syndromes on reducing treatment of pediatric asthma: A systematic review

“…A total of 1559 references were identified through database searching and 11 additional through reference reviews. After removing duplicates and identifying records from other sources (reference lists of reviews), the titles and abstracts of 1076 studies were screened for relevance, and 31 studies were selected for full‐text review for eligibility, resulting in the inclusion of eight cohort studies: one retrospective chart review, one prospective, and six observational cohort studies 22–29 . No randomized controlled trials (RCTs) were identified.…”

“…After removing duplicates and identifying records from other sources (reference lists of reviews), the titles and abstracts of 1076 studies were screened for relevance, and 31 studies were selected for fulltext review for eligibility, resulting in the inclusion of eight cohort studies: one retrospective chart review, one prospective, and six observational cohort studies. [22][23][24][25][26][27][28][29] No randomized controlled trials (RCTs) were identified. Eight case studies were identified but excluded from the analysis.…”

“…The risk of bias for all included studies was ranked probably high, based on the OHAT criteria assessment (Figure 2). Six studies 22,24,25,[27][28][29] had unclear evaluation results for all six potential domain-based sources of bias (participant selection, confounding, attrition/exclusion, detection, selective reporting, and other sources).…”

“…Laryngoscopy, the gold standard, 30 22 Rameau et al 25 Sullivan et al 26 Vance et al 27 No formal therapy (%) T A B L E 3 Summarized characteristics of patients with a suspected asthma diagnosis before evaluation for ILO from each of the included studies Doshi et al 22 Fulton et al 23 Hseu et al 24 Rameau et al 25 Sullivan et al 26 Vance et al 27 Yibrehu et al 28 Ivancic et al 29 Trend The GRADE method was used to summarize the evidence for interventions (Table 4). 21 There is moderate certainty of evidence that SLP and/or behavioral therapy provide improvement in symptoms, [22][23][24][25][26][27][28][29] and a very low certainty of evidence supporting an anticholinergic inhaler 22,24 or Botox therapy 27 to improve symptoms.…”

“…34,35 Several studies reported comorbidity including GERD. Laryngopharyngeal reflux may increase laryngeal inflammation, and ILO pathophysiology may contribute to GERD symptoms in some T A B L E 3 (Continued) Doshi et al 22 Fulton et al 23 Hseu et al 24 Rameau et al 25 Sullivan et al 26 Vance et al 27 Yibrehu et al 28 Ivancic et al 29 patients. 30 The proposed mechanism is through increased negative intrathoracic pressure generated during work of breathing with ILO overcoming esophageal opening pressure.…”