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Reduced Asthma Medication Use after Treatment of Pediatric Paradoxical Vocal Fold Motion Disorder
Ryan Ivancic1,2, Laura Matrka1, Gregory Wiet3
1Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Insights
Diagnosing and treating pediatric Paradoxical Vocal Fold Motion Disorder (PVFMD) can decrease asthma medication use, especially with full therapy or exercise-induced cases. This treatment also significantly reduces breathing difficulties in children.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Speech-Language Pathology
Background:
- Paradoxical Vocal Fold Motion Disorder (PVFMD) is a condition affecting breathing in children, often misdiagnosed as asthma.
- Asthma medication is frequently prescribed to children with PVFMD, potentially leading to unnecessary treatment.
Purpose of the Study:
- To investigate if diagnosing and treating pediatric PVFMD reduces asthma medication reliance.
- To assess the impact of PVFMD diagnosis and treatment on patients' dyspnea (shortness of breath).
Main Methods:
- A prospective observational study involving 26 pediatric patients (ages 11-17) with newly diagnosed PVFMD.
- Patients completed questionnaires on medication use and the Dyspnea Index (DI) at baseline and follow-up.
- Intervention included Laryngeal Control Therapy (LCT), focusing on breathing techniques and identifying triggers.
Main Results:
- 100% of patients used inhalers pre-enrollment; 73% had a prior asthma diagnosis.
- Significant reduction in asthma medication use was observed in the full LCT group and those with exercise-induced PVFMD.
- Overall Dyspnea Index scores decreased significantly from 25.5 to 18.8 (P < .001).
Conclusions:
- Diagnosing and treating pediatric PVFMD, particularly with adequate LCT, can decrease asthma medication use.
- Laryngeal Control Therapy effectively reduces respiratory symptoms in children with PVFMD, as measured by the Dyspnea Index.
Objectives/Hypotheses:
The primary objective of this study was to determine whether the diagnosis and treatment of pediatric Paradoxical Vocal Fold Motion Disorder (PVFMD) leads to decreased asthma medication use. Our secondary objective was to determine dyspnea outcomes following diagnosis and treatment for PVFMD.
Study Design:
Prospective observational study.
Methods:
Patients with newly diagnosed PVFMD between the ages of 11 and 17 were recruited at a single pediatric institution. A medication questionnaire and Dyspnea Index (DI) were completed at the initial visit, at the first return visit, and at greater than 6 months post-diagnosis and therapy. Laryngeal Control Therapy (LCT) consisted of teaching breathing techniques and identifying emotional, physical, and environmental contributing factors and strategies to reduce them.
Results:
Twenty-six patients were recruited to the study. There were 19/26 (73%) patients diagnosed with asthma prior to a diagnosis of PVFMD, and 26/26 (100%) patients were using an inhaler prior to the enrollment visit. Twenty-two (85%) patients completed follow-up questionnaires. Five patients participated in no therapy, seven patients in partial therapy, and 14 patients in full therapy. Significant reduction in asthma medication use was seen in the full therapy group (P < .05) and in those with exercise as their only trigger (P < .05). Furthermore, symptoms as scored by the DI decreased overall from 25.5 to 18.8 (P < .001).
Conclusions:
Diagnosis and treatment of pediatric PVFMD leads to a decline in asthma medication use in those patients who participate in at least two LCT sessions and in those with exercise-induced PVFMD. LCT for pediatric PVFMD leads to a significant decrease in symptoms as measured by the DI.
Level Of Evidence:
4 Laryngoscope, 131:1639-1646, 2021.
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