声带功能障碍/诱导性喉梗阻:新的诊断和治疗方法。

IF 2.9 3区 医学 Q2 RESPIRATORY SYSTEM
Expert Review of Respiratory Medicine Pub Date : 2023-01-01 Epub Date: 2023-05-22 DOI:10.1080/17476348.2023.2215434
Joo Koh, Debra Phyland, Malcolm Baxter, Paul Leong, Philip G Bardin
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引用次数: 0

摘要

引言:声带功能障碍/可诱导性喉梗阻(VCD/ILO)是一种重要的医学状况,但对其了解尚不完善。它发生在健康人身上,但经常与哮喘共存。VCD/ILO病理生理学模型强调的是易感因素,而不是特定的机制,并且疾病表达在人与人之间存在差异,这一点很少得到重视。诊断往往被延迟,治疗也没有依据。涵盖的领域:已经提出了统一的病理生理模型和疾病表型。传统上,在声带狭窄>50%的吸气过程中通过喉镜进行诊断。最近,动态CT喉部显示出高特异性(>80%),有可能成为一种无创、快速和可量化的诊断模式。治疗需要通过言语病理学干预和实验疗法(如肉毒杆菌毒素注射)对喉部进行再训练。多学科团队(MDT)诊所是一项新的创新,其益处已得到证明,包括准确诊断、选择适当的治疗和减少口服皮质类固醇暴露。专家意见:VCD/ILO的延迟诊断是普遍存在的,通常会导致有害的治疗。表型需要验证,CT喉部可以减少喉镜检查的必要性,从而快速跟踪诊断。MDT诊所可以优化管理。随机对照试验对于验证言语病理干预和其他治疗模式以及建立国际护理标准至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics.

Introduction: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based.

Areas covered: A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure.

Expert opinion: Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.

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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
90
期刊介绍: Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity
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