Page 16 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 16
structures. In pediatric patients, it is hypoth- of VCD is greater than 4 years8. Patients with
esized that increased laryngeal diameter due asthma may also have comorbidities, such as
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma to growth might spontaneously improve their VCD, which are associated with worse asth-
exercise capacity26. Asthma is common in en- ma outcomes, increased symptoms, more ex-
durance sports athletes, likewise the preva- acerbations, and poorer quality of life24. Im-
lence of EILO is high. Cross-country skiers proved VCD control can reduce asthma
and biathletes have a very high prevalence medication use18,23.
of asthma and EILO. Coexisting EILO and
asthma seem to be common in skiers, espe- Important differential diagnosis od VCD
cially females. It is mainly believed to be due
to repeated and prolonged inhalation of cold Patients with VCD are often misdiagnosed
dry air, therefore, leading to osmotic chang- as having refractory asthma, which can lead
es and epithelial damage in the airways19. La- to unnecessary morbidity and high medical
ryngopharyngeal reflux, allergy, infections, utilization, unnecessary drug use and high
irritants, temperature, the humidity of the air dose corticosteroid use, emergency room vis-
in the surroundings, and psychological aspect its, hospitalizations, and even intubation.
are also the etiological factors of EILO15. They found that 42% of all VCD subjects
had been previously misdiagnosed with asth-
Other possible etiologies for VCD ma for an average of 9 years9,34. The differ-
ential list for suspected VCD is broad and in-
There are some other factors as extubation af- cludes any disorder with episodic dyspnea,
ter general anesthesia. Central neurological cough, and wheezing. There are many mim-
disorders like Arnold Chiari malformation, ickers of VCD, with asthma at the top of the
Parkinson’s syndromes, ALS (amyotrophic list. Other conditions are psychogenic disor-
lateral sclerosis), and others may be associat- ders, anaphylaxis, aspiration of foreign body,
ed with VCD18. angioedema, chronic obstructive pulmonary
disease, croup, epiglottitis, extrinsic airway
Clinical features of VCD compression, laryngomalacia, laryngospasm,
laryngeal tumor, laryngeal dystonia, exer-
Clinical presentation can be very variable, cise-induced bronchospasm, vocal cord pare-
ranging from no symptoms to mild dyspnea, sis, laryngeal and tracheal stenosis, and oth-
and acute onset respiratory distress, which can ers9,18,35.
mimic an asthma attack9. VCD episodes fre-
quently begin and end abruptly. Patients are Diagnosis of VCD
not hypoxic and have a normal level of con-
sciousness. If the patient is with altered men- Diagnosis is made by careful history, physical
tal status or hypoxemia, more serious causes examination – laryngoscopy, and spirometry
should be considered. Symptoms are period- or pulmonary function testing9. Imaging has
ic: shortness of breath, asthma-like symptoms no role in the evaluation of VCD32. A careful
during exercise, and intense emotion, which history is very important. We should be sus-
does not respond to asthma drugs. Other picious in a patient with asthma-like symp-
symptoms are air hunger, dyspnea, choking toms unresponsive to bronchodilators or cor-
sensation, chest pain, stridor, voice changes, ticosteroids, absence of nocturnal symptoms,
difficulty in speaking and swallowing, globus and more difficulty with inspiration than ex-
sensation, intermittent aphonia, dysphonia, piration. Asthma inhalers can even trigger or
chronic cough, throat clearing, panic, and exacerbate symptoms1. Symptoms in VCD
anxiety which worsen respiratory symptoms9. patients are precipitated by stress, emotion-
The period from symptom onset to diagnosis al factors, or anxiety. The patient has no spu-
esized that increased laryngeal diameter due asthma may also have comorbidities, such as
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma to growth might spontaneously improve their VCD, which are associated with worse asth-
exercise capacity26. Asthma is common in en- ma outcomes, increased symptoms, more ex-
durance sports athletes, likewise the preva- acerbations, and poorer quality of life24. Im-
lence of EILO is high. Cross-country skiers proved VCD control can reduce asthma
and biathletes have a very high prevalence medication use18,23.
of asthma and EILO. Coexisting EILO and
asthma seem to be common in skiers, espe- Important differential diagnosis od VCD
cially females. It is mainly believed to be due
to repeated and prolonged inhalation of cold Patients with VCD are often misdiagnosed
dry air, therefore, leading to osmotic chang- as having refractory asthma, which can lead
es and epithelial damage in the airways19. La- to unnecessary morbidity and high medical
ryngopharyngeal reflux, allergy, infections, utilization, unnecessary drug use and high
irritants, temperature, the humidity of the air dose corticosteroid use, emergency room vis-
in the surroundings, and psychological aspect its, hospitalizations, and even intubation.
are also the etiological factors of EILO15. They found that 42% of all VCD subjects
had been previously misdiagnosed with asth-
Other possible etiologies for VCD ma for an average of 9 years9,34. The differ-
ential list for suspected VCD is broad and in-
There are some other factors as extubation af- cludes any disorder with episodic dyspnea,
ter general anesthesia. Central neurological cough, and wheezing. There are many mim-
disorders like Arnold Chiari malformation, ickers of VCD, with asthma at the top of the
Parkinson’s syndromes, ALS (amyotrophic list. Other conditions are psychogenic disor-
lateral sclerosis), and others may be associat- ders, anaphylaxis, aspiration of foreign body,
ed with VCD18. angioedema, chronic obstructive pulmonary
disease, croup, epiglottitis, extrinsic airway
Clinical features of VCD compression, laryngomalacia, laryngospasm,
laryngeal tumor, laryngeal dystonia, exer-
Clinical presentation can be very variable, cise-induced bronchospasm, vocal cord pare-
ranging from no symptoms to mild dyspnea, sis, laryngeal and tracheal stenosis, and oth-
and acute onset respiratory distress, which can ers9,18,35.
mimic an asthma attack9. VCD episodes fre-
quently begin and end abruptly. Patients are Diagnosis of VCD
not hypoxic and have a normal level of con-
sciousness. If the patient is with altered men- Diagnosis is made by careful history, physical
tal status or hypoxemia, more serious causes examination – laryngoscopy, and spirometry
should be considered. Symptoms are period- or pulmonary function testing9. Imaging has
ic: shortness of breath, asthma-like symptoms no role in the evaluation of VCD32. A careful
during exercise, and intense emotion, which history is very important. We should be sus-
does not respond to asthma drugs. Other picious in a patient with asthma-like symp-
symptoms are air hunger, dyspnea, choking toms unresponsive to bronchodilators or cor-
sensation, chest pain, stridor, voice changes, ticosteroids, absence of nocturnal symptoms,
difficulty in speaking and swallowing, globus and more difficulty with inspiration than ex-
sensation, intermittent aphonia, dysphonia, piration. Asthma inhalers can even trigger or
chronic cough, throat clearing, panic, and exacerbate symptoms1. Symptoms in VCD
anxiety which worsen respiratory symptoms9. patients are precipitated by stress, emotion-
The period from symptom onset to diagnosis al factors, or anxiety. The patient has no spu-
