Abstract
Background: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inap- propriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD.
Methods: A prospective observational study involving 80 patients aged
≥18 years, diagnosed with severe
asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer “yes” counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n =14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list.
Results: The proportion of affirmative answers to the question “Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?” was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable “4 or more affirmative answers” was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022).
Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryn- goscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
