Inducible Laryngeal Obstruction/Vocal Cord Dysfunction and the Role It Plays in Refractory Asthma
- Publication date
- 2017
- Publisher
Abstract
Chronic asthma accounts for a significant amount of unscheduled office
and emergency department (ED) visits. According to the latest World
Health Organization statistics, asthma worldwide affects 300 million
individuals and creates a substantial health burden by restricting the
patient’s lifetime activities. Data estimate that asthma causes a loss
of disability-adjusted life years over 150,000/year [1]. While most
individuals with asthma can be controlled with current therapies, 5-10%
of patients have difficult-to-control/refractory asthma. Severe or
refractory asthma places a significant burden on the patient and often
requires treatment with systemic glucocorticoids, which have significant
side effects. The American Thoracic Society and the European
Respiratory Society define refractory asthma as asthma that requires
treatment with high-dose inhaled corticosteroids (ICS) plus a second
controller and/or systemic corticosteroids to prevent it from becoming
‘‘uncontrolled’’ or asthma that remains ‘‘uncontrolled’’ despite this
aggressive therapy. To fully meet this definition the diagnosis of
asthma needs to be confirmed and comorbidities addressed as well. The
above are considered major criteria for severe asthma and only one needs
to be present for considering the diagnosis of refractory asthma [2].
For these reasons, clinicians must learn to identify and formulate
additional diagnoses of “asthma imitators” [3]. One of the more common
disorders associated with difficult-to-control asthma is vocal cord
dysfunction (VCD) [4]. This disorder is known by many names, but current
nomenclature endorsed by European and American societies correctly
refers it as “Inducible Laryngeal Obstruction” (ILO) [5]. The following
case demonstrates the importance of recognizing the clinical and
spirometric features of ILO when asthma remains “refractory” to multiple
therapies