Case Report

Inducible Laryngeal Obstruction/Vocal Cord Dysfunction and the Role It Plays in Refractory Asthma

Jay I Peters*, Jorge Villalpando and Sandra G Adams

Published: 23 August, 2017 | Volume 1 - Issue 1 | Pages: 036-039

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.

Read Full Article HTML DOI: 10.29328/journal.haard.1001005 Cite this Article Read Full Article PDF


  1. World Health Organization. Media Center. Asthma Key Facts. 2017; Ref.: https://goo.gl/T97UX8
  2. Chung K, Wenzel S, Brozek J, Bush A, Castro M, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014; 43: 343-373. Ref.: https://goo.gl/SrCSCu
  3. Walsted ES, Hull JH, Sverrild A, Porsbjerg C, Backer V. Bronchial provocation testing does not detect exercise-induced laryngeal obstruction. J Asthma. 2017; 54: 77-83. Ref.: https://goo.gl/PmRDA9
  4. Balkissoon R, Blager F. Vocal cord dysfunction Often Misdiagnosed and Treated Inappropriately. Medical Scientific. 2002; 19. Ref.: https://goo.gl/HxM7v4
  5. Christensen PM, Heimdal JH, Christopher KL, Bucca C, Cantarella G, et al. ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions. Eur Resp Rev. 2015; 24: 445-450. Ref.: https://goo.gl/JkAbxh
  6. Heaney LG, Brightling CE, Menzies-Gow A, Stevenson M, Niven RM, et al. British Thoracic Society Difficult Asthma Network. Thorax. 2010; 65: 787-94. Ref.: https://goo.gl/sot96d
  7. Chanez P, Wenzel SE, Anderson GP, Anto JM, Bel EH, et al. Severe asthma in adults: what are the important questions? J Allergy Clin Immunol. 2007; 119: 1337-1348. Ref.: https://goo.gl/BbL4Mi
  8. Holgate ST. Polosa R. The mechanisms, diagnosis, and management of severe asthma in adults. Lancet. 2006; 368: 780-793. Ref.: https://goo.gl/CTx1Rf
  9. Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010; 138: 1213-1223. Ref.: https://goo.gl/R2hNbo
  10. Yelken K, Yilmaz A, Guven M, Eyibilen A, Aladag I. Paradoxical vocal fold motion dysfunction in asthma patients. Respirology. 2009; 14: 729-733. Ref.: https://goo.gl/pLQ9Td
  11. McNicholl DM, Megarry J, McGarvey LP, Riley MS, Heaney LG. The utility of cardiopulmonary exercise testing in difficult asthma. Published in Chest. 2011; 139: 1117-1123.  : https://goo.gl/97pYaQ
  12. Hicks M, Brugman SM, Katial R. Vocal cord dysfunction/paradoxical vocal fold motion. Prim Care. 2008; 35: 81-103. Ref.: https://goo.gl/5AaJeb


Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?