Voice and upper airway symptoms in severe asthma
|Associate Professor Anne Vertigan
John Hunter Hospital
A/Prof Anne Vertigan is the manager of speech pathology for John Hunter Hospital and Belmont Hospital in Newcastle Australia, and Conjoint Associate Professor in the School of Medicine and Public Health at the University of Newcastle Australia. She graduated from Latrobe University in Melbourne with a Bachelor of Applied Science in Speech Pathology, a Master of Business Administration from the University of Newcastle and a PhD through the University of Queensland. Anne’s clinical load includes acute inpatients, and outpatients voice disorders, chronic cough/VCD, laryngectomy and dysphagia. She is the speech pathologist in the Severe Asthma Clinic at John Hunter Hospital and chair of the Hunter New England Allied Health Research Network and the Hunter New England Research Ethics Committee. Research interests include voice disorders, chronic cough/VCD and voice & upper airway disorders in asthma. Anne has conducted several research projects in the area of chronic cough and PVFM and published the first text book on speech pathology management of these conditions.
Why was funding this research important?
Vocal cord dysfunction is involuntary and intermittent closure of the vocal cords during breathing. It is a poorly recognised comorbidity of asthma, even though it can exacerbate asthma symptoms, affect quality of life and interfere with adherence to asthma medication. Vocal cord dysfunction can also be misinterpreted by patients and clinicians as worsening asthma and lead to unnecessary escalation of asthma treatment. Triggers of vocal cord dysfunction may be similar to those of asthma, including exercise, psychological conditions, airborne irritants and the common cold. The nature of voice and upper airway symptoms in patients with asthma is unknown and pathways for effective assessment and treatment have not been defined
What did the researchers do?
This project examined the voice and upper airway symptoms in 55 patients with severe asthma who were referred to a tertiary hospital for management. Patient examination included assessment of patient reported symptoms, quality of life, voice analysis, and examination and tests of vocal fold function. They also sought patient’s opinions regarding the impact of voice and upper airway symptoms on their daily activities and wellbeing.
What was the outcome
The researchers found participants average voice related quality of life scores were outside of the normal range, suggesting there were negative impacts for people with asthma from the physical, emotional and functional aspects of voice production. Testing showed that participants with severe asthma had a higher degree of discomfort or irritation in their throat and increased cough symptoms, even when their asthma was optimally medically controlled. These symptoms also had a negative impact on their quality of life. 80% of participants with severe asthma had laryngeal dysfunction. It is possible that both upper airway symptoms are being misinterpreted as asthma exacerbations and that patients may be misdiagnosed as having asthma when they have vocal cord dysfunction. Voice and upper airway symptoms should be screened in patients with severe asthma as a minimum. Patients exhibiting symptoms should be referred for more extensive investigations and treatment. Further research should be conducted to determine the efficacy of treatment for these symptoms in severe asthma.
“This research shows that there is a high degree of laryngeal dysfunction in patients with severe asthma and therefore voice and upper airway disorders may need to be screened in patients with refractory asthma.” Associate Professor Anne Vertigan
Vertigan, Kapela, Gibson, Laryngeal Dysfunction in Severe Asthma: A Cross-Sectional Observational Study, J Allergy Clin Immunol Pract. 2020 Oct 1:S2213-2198(20)31012-6. doi: