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Differentiating vocal cord dysfunction from asthma

Authors Fretzayas A, Moustaki M, Loukou I, Douros K

Received 11 July 2017

Accepted for publication 3 September 2017

Published 12 October 2017 Volume 2017:10 Pages 277—283

DOI https://doi.org/10.2147/JAA.S146007

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Amrita Dosanjh

Andrew Fretzayas,1,2 Maria Moustaki,3 Ioanna Loukou,3 Konstantinos Douros4

1Third Department of Pediatrics, Athens University Medical School, “Attikon” University Hospital, Haidari, Greece; 2Athens Medical Center, Department of Pediatrics, Marousi, Greece; 3Department of Cystic Fibrosis, “Aghia Sofia”, Children’s Hospital, Athens, Greece; 4Respiratory Unit, Third Department of Pediatrics, Athens University Medical School, “Attikon” University Hospital, Haidari, Greece

Abstract: Vocal cord dysfunction (VCD)-associated symptoms are not rare in pediatric patients. Dyspnea, wheezing, stridor, chest pain or tightness and throat discomfort are the most commonly encountered symptoms. They may occur either at rest or more commonly during exercise in patients with VCD, as well as in asthmatic subjects. The phase of respiration (inspiration rather than expiration), the location of the wheezing origin, the rapid resolution of symptoms, and the timing occurring in relation to exercise, when VCD is exercise induced, raise the suspicion of VCD in patients who may have been characterized as merely asthmatics and, most importantly, had not responded to the appropriate treatment. The gold standard method for the diagnosis of VCD is fiberoptic laryngoscopy, which may also identify concomitant laryngeal abnormalities other than VCD. However, as VCD is an intermittent phenomenon, the procedure should be performed while the patient is symptomatic. For this reason, challenges that induce VCD symptoms should be performed, such as exercise tests. Recently, for the evaluation of patients with exercise-induced VCD, continuous laryngoscopy during exercise (such as treadmill, bicycle ergometer, swimming) was used. A definite diagnosis of VCD is of importance, especially for those patients who have been erroneously characterized as asthmatics, without adequate response to treatment. In these cases, another therapeutic approach is necessary, which will depend on whether they suffer solely from VCD or from both conditions.

Keywords: asthma, children, laryngoscopy, vocal cord dysfunction, inducible laryngeal obstruction, ILO, continuous laryngoscopy exercise test, CLE

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