Page 18 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 18
mary care physician, pulmonologist, aller- to repeat them often, to ensure that a pa-
gist, ENT doctor, gastroenterologist, neurol- tient can respond automatically when acute-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma ogist, psychiatrist and psychologist, speech ly symptomatic (5 repetitions 20 times per
pathologist and athletic trainer participate in day). Phonation of soft “s” sound while ex-
the treatment. Effective long-term therapy re- haling, is successful to divert attention from
quires psychosocial support, speech therapy, inhalation, and give auditory feedback on
and biofeedback9. air movement. Another maneuver is panting,
which activates the PCA muscle, a laryngeal
Speech therapy abductor. Coughing and sniffing are also re-
leasing maneuvers. Sniffing reduces air tur-
Speech therapy is the cornerstone of the treat- bulence and shifts the narrowest part of the
ment18. It is the most common long-term treat- breath from the larynx to the nose. Common
ment of VCD. Patients are educated about the breathing techniques include jaw trust, nasal
pathophysiology of VCD and are educated inspiration with pursed-lip exhalation, and
about the suppression of laryngeal abusive be- breathing through a large-diameter straw or
haviors (cough and throat clearing). Patients cut endotracheal tube. These techniques are
are trained on how to control the laryngeal designed to interrupt the irregular respirato-
area and maintain an adequately open air- ry pattern or spasm and allow familiar neu-
way during respiration. Patient are allowed rologic signals to reengage and relax the vo-
to view their laryngoscopy, to understand and cal folds8,18,30.
accept the disease. Visual feedback allows the
patient to modify their breathing, visual feed- EILOBI breathing techniques
back enables a reduction in symptoms and the
use of medication. Breathing techniques are In EILO adduction of the vocal folds and/or
learned by the speech and language therapist inspiratory prolapse of the supraglottic struc-
(SLT), and VCD symptoms, and triggers are tures during high-intensity exercise appears.
assessed. Patient education is a crucial com- Although respiratory retraining is a prima-
ponent of the treatment. The therapist offers ry therapy of EILO, many patients report
supportive counseling. Respiratory retrain- symptom persistence despite the adequate
ing is practiced by the SLT. Desensitization performance of traditional techniques. EI-
is attempted to be achieved for specific irri- LOBI (EILO biphasic) inspiratory breathing
tants. Voice therapy and different breathing techniques are novel breathing techniques
techniques are practiced – quick release tech- for EILO therapy20. Patients are encouraged
niques and different maneuvers. Studies have to train in biphasic inspiratory breathing:
shown that speech therapy can achieve symp- from high inspiratory resistance then rapid-
tom control and eliminate emergency depart- ly changed to low resistance breathing. High
ment visits in 90% of patients with VCD8,14,23. resistance inspiratory phase (tongue vari-
Non-pulmonary-related shortness of breath ant - inhaling through the nose, tooth vari-
treated with respiratory retraining can effec- ant - inhaling through the teeth placed firm-
tively eliminate dyspnea. The patient should ly against the lower lip, lip variant - inhaling
perform respiratory retraining exercises three through the pursed lips) is followed by low
to four times daily for four weeks, and daily resistance inspiratory phase – inhalation
exercises for two additional months13. through a wide-open mouth. Thus, optimiz-
ing the glottic aperture with maneuvers that
Treatment of VCD – m aneuvers can be performed during high-intensity exer-
cise is achieved .8,30
Different maneuvers can be used to achieve
a quick release of symptoms. It is necessary
gist, ENT doctor, gastroenterologist, neurol- tient can respond automatically when acute-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma ogist, psychiatrist and psychologist, speech ly symptomatic (5 repetitions 20 times per
pathologist and athletic trainer participate in day). Phonation of soft “s” sound while ex-
the treatment. Effective long-term therapy re- haling, is successful to divert attention from
quires psychosocial support, speech therapy, inhalation, and give auditory feedback on
and biofeedback9. air movement. Another maneuver is panting,
which activates the PCA muscle, a laryngeal
Speech therapy abductor. Coughing and sniffing are also re-
leasing maneuvers. Sniffing reduces air tur-
Speech therapy is the cornerstone of the treat- bulence and shifts the narrowest part of the
ment18. It is the most common long-term treat- breath from the larynx to the nose. Common
ment of VCD. Patients are educated about the breathing techniques include jaw trust, nasal
pathophysiology of VCD and are educated inspiration with pursed-lip exhalation, and
about the suppression of laryngeal abusive be- breathing through a large-diameter straw or
haviors (cough and throat clearing). Patients cut endotracheal tube. These techniques are
are trained on how to control the laryngeal designed to interrupt the irregular respirato-
area and maintain an adequately open air- ry pattern or spasm and allow familiar neu-
way during respiration. Patient are allowed rologic signals to reengage and relax the vo-
to view their laryngoscopy, to understand and cal folds8,18,30.
accept the disease. Visual feedback allows the
patient to modify their breathing, visual feed- EILOBI breathing techniques
back enables a reduction in symptoms and the
use of medication. Breathing techniques are In EILO adduction of the vocal folds and/or
learned by the speech and language therapist inspiratory prolapse of the supraglottic struc-
(SLT), and VCD symptoms, and triggers are tures during high-intensity exercise appears.
assessed. Patient education is a crucial com- Although respiratory retraining is a prima-
ponent of the treatment. The therapist offers ry therapy of EILO, many patients report
supportive counseling. Respiratory retrain- symptom persistence despite the adequate
ing is practiced by the SLT. Desensitization performance of traditional techniques. EI-
is attempted to be achieved for specific irri- LOBI (EILO biphasic) inspiratory breathing
tants. Voice therapy and different breathing techniques are novel breathing techniques
techniques are practiced – quick release tech- for EILO therapy20. Patients are encouraged
niques and different maneuvers. Studies have to train in biphasic inspiratory breathing:
shown that speech therapy can achieve symp- from high inspiratory resistance then rapid-
tom control and eliminate emergency depart- ly changed to low resistance breathing. High
ment visits in 90% of patients with VCD8,14,23. resistance inspiratory phase (tongue vari-
Non-pulmonary-related shortness of breath ant - inhaling through the nose, tooth vari-
treated with respiratory retraining can effec- ant - inhaling through the teeth placed firm-
tively eliminate dyspnea. The patient should ly against the lower lip, lip variant - inhaling
perform respiratory retraining exercises three through the pursed lips) is followed by low
to four times daily for four weeks, and daily resistance inspiratory phase – inhalation
exercises for two additional months13. through a wide-open mouth. Thus, optimiz-
ing the glottic aperture with maneuvers that
Treatment of VCD – m aneuvers can be performed during high-intensity exer-
cise is achieved .8,30
Different maneuvers can be used to achieve
a quick release of symptoms. It is necessary
