Page 19 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 19
piratory muscle training devices and effective option for individuals with mod- 19
erate to severe supraglottic-type EILO who
Treatment of EILO in athletes and other pa- have failed initial conservative treatment10. dysfunctional breathing – view of otorhinolaryngologist
tients with VCD with inspiratory muscle
training devices is possible. It is a conservative Botulinum toxin
treatment tool to achieve better control of the
vocal folds. Patients can use resistive flow-de- Botulinum toxin laryngeal injection is rarely
pendent devices. The inspiratory valve in- used in VCD treatment. Chemical denerva-
creases resistance to inspiration and decreases tion is achieved and paralysis, the vocal folds
the inspiratory rate of airflow, consequently, are in the open position. It is useful in laryn-
there is less turbulence and less stimulation geal dystonia. It is used only in severe cases of
of the vocal folds4. Another one is the use of refractory VCD, that do not respond to con-
continuous positive airway pressure – CPAP ventional therapy, and in patients with re-
to relieve acute symptoms of VCD. CPAP re- fractory dyspnea symptoms following ap-
lieves dyspnea by slowing the expiratory flow, propriate medical therapy and respiratory
thereby increasing lung volume, which in retraining protocols28,36.
turn results in a more open glottis. CPAP is
also reducing the effort needed for inspiration Treatment of VCD with medications
by establishing a favorable pressure gradient – pharmacotherapy
for inhalation18. In persistently symptomatic patients, mild
sedatives may facilitate VCD management.
Psychotherapy Benzodiazepines are effective in terminating
acute symptoms and relieving anxiety. Before
Psychotherapy remains an important mode giving this medication, we should confirm
of treatment in patients with VCD. There are normal oxygen saturation and exclude hy-
many forms of psychotherapy used in VCD, percapnia18. When breathing techniques are
which include relaxation therapy to alleviate unsuccessful, helium-oxygen inhalation and
the distress associated with symptoms, identi- noninvasive positive-pressure ventilation may
fication of stressors, development of new cop- be successful in resolving VCD. Heliox is the
ing strategies for dealing with stressors, family mixture of oxygen (20%) and helium (80%),
therapy, and behavioral cognitive therapy18. it is less dense than air and reduces the work of
Hypnosis and self-hypnosis induce relax- breathing. Inhalation of Heliox reduces tur-
ation. Biofeedback may be used in conjunc- bulence in the airway and eliminates respira-
tion with psychotherapy for treating patients tory noise7,18. In some centers, they use inhala-
with VCD2,3,12,17,25. tion of anticholinergic drugs. Neuromuscular
treatment such as Gabapentin is successful in
Surgical treatment some patients. GORD treatment is reasonable
if GORD is proven, the success of such treat-
Surgical treatment – supraglottoplasty is used ment is very good in those patients in whom
only in refractory cases. It gives good results reflux has been demonstrated21,31.
in selected patients. The most commonly used
method is to cut the aryepiglottic folds clos- Prognosis
er to the epiglottis and to remove the muco-
sa and cuneiform cartilage from the aryepi- VCD is a benign and self-limiting disorder.
glottic fold with the help of a laser. The use The majority of patients respond to speech
of a suture that pulls the epiglottis towards therapy. There are no long sequelae18,32.
the root of the tongue and lateralization of
one vocal fold with the suture are also de-
scribed27,39. EILO surgery appears to be a safe
erate to severe supraglottic-type EILO who
Treatment of EILO in athletes and other pa- have failed initial conservative treatment10. dysfunctional breathing – view of otorhinolaryngologist
tients with VCD with inspiratory muscle
training devices is possible. It is a conservative Botulinum toxin
treatment tool to achieve better control of the
vocal folds. Patients can use resistive flow-de- Botulinum toxin laryngeal injection is rarely
pendent devices. The inspiratory valve in- used in VCD treatment. Chemical denerva-
creases resistance to inspiration and decreases tion is achieved and paralysis, the vocal folds
the inspiratory rate of airflow, consequently, are in the open position. It is useful in laryn-
there is less turbulence and less stimulation geal dystonia. It is used only in severe cases of
of the vocal folds4. Another one is the use of refractory VCD, that do not respond to con-
continuous positive airway pressure – CPAP ventional therapy, and in patients with re-
to relieve acute symptoms of VCD. CPAP re- fractory dyspnea symptoms following ap-
lieves dyspnea by slowing the expiratory flow, propriate medical therapy and respiratory
thereby increasing lung volume, which in retraining protocols28,36.
turn results in a more open glottis. CPAP is
also reducing the effort needed for inspiration Treatment of VCD with medications
by establishing a favorable pressure gradient – pharmacotherapy
for inhalation18. In persistently symptomatic patients, mild
sedatives may facilitate VCD management.
Psychotherapy Benzodiazepines are effective in terminating
acute symptoms and relieving anxiety. Before
Psychotherapy remains an important mode giving this medication, we should confirm
of treatment in patients with VCD. There are normal oxygen saturation and exclude hy-
many forms of psychotherapy used in VCD, percapnia18. When breathing techniques are
which include relaxation therapy to alleviate unsuccessful, helium-oxygen inhalation and
the distress associated with symptoms, identi- noninvasive positive-pressure ventilation may
fication of stressors, development of new cop- be successful in resolving VCD. Heliox is the
ing strategies for dealing with stressors, family mixture of oxygen (20%) and helium (80%),
therapy, and behavioral cognitive therapy18. it is less dense than air and reduces the work of
Hypnosis and self-hypnosis induce relax- breathing. Inhalation of Heliox reduces tur-
ation. Biofeedback may be used in conjunc- bulence in the airway and eliminates respira-
tion with psychotherapy for treating patients tory noise7,18. In some centers, they use inhala-
with VCD2,3,12,17,25. tion of anticholinergic drugs. Neuromuscular
treatment such as Gabapentin is successful in
Surgical treatment some patients. GORD treatment is reasonable
if GORD is proven, the success of such treat-
Surgical treatment – supraglottoplasty is used ment is very good in those patients in whom
only in refractory cases. It gives good results reflux has been demonstrated21,31.
in selected patients. The most commonly used
method is to cut the aryepiglottic folds clos- Prognosis
er to the epiglottis and to remove the muco-
sa and cuneiform cartilage from the aryepi- VCD is a benign and self-limiting disorder.
glottic fold with the help of a laser. The use The majority of patients respond to speech
of a suture that pulls the epiglottis towards therapy. There are no long sequelae18,32.
the root of the tongue and lateralization of
one vocal fold with the suture are also de-
scribed27,39. EILO surgery appears to be a safe
