Mirza Natasha, Kasper Schwartz Sandra, Antin-Ozerkis Danielle
Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
Laryngoscope. 2004 Sep;114(9):1566-9. doi: 10.1097/00005537-200409000-00012.
At the conclusion of this article, the readers should be able to 1) describe the laryngeal findings in patients who use combination therapy for asthma, 2) discuss the mechanism of laryngeal irritation from the use of inhalers, and 3) describe possible mechanisms for reducing laryngeal irritation and secondary dysphonia from the use of inhalers.
To describe voice changes and laryngeal findings in patients who are started on combination corticosteroid and bronchodilator therapy in the form of a dry powder inhaler (DPI).
Retrospective, single-subject design.
Retrospective review of 10 consecutive patients meeting inclusion criteria, who presented at the voice center with more than 4 weeks of dysphonia after being started on a combination form of asthma medication for control and maintenance therapy. All patients were nonsmokers and without history of previous identification or excision of vocal pathology. All patients were treated previously with a proton pump inhibitor for gastroesophageal reflux. Laryngeal videostroboscopic evaluations were performed on all patients. Patients were asked to complete a questionnaire regarding their perceived voice change and history of medical maintenance therapy for asthma.
Dysphonia was present in the patients selected for greater than 4 weeks. Patients had been switched to combination therapy after previously using traditional two-drug asthma regimens. In eight of nine patients, the vocal folds demonstrated areas of hyperemia, with plaque-like changes on the surface mucosa. Reduced amplitude of vibration and a reduction in mucosal wave propagation were present on videostroboscopy. Questionnaires revealed that all patients were initiated on combination DPI treatment within the last 6 months.
Dysphonia caused by a change in the surface mucosa is a side effect from the use of DPI therapy for asthma. The high-impact force during inhalation of the medication and carrier leads to deposition of particles in the upper airway. We believe the extent of mucosal irritation can be minimized by patient education in the proper delivery of DPI. In some cases, however, return of the two medications delivered separately was necessary. The irritation of the laryngeal mucosa and return of normal vibratory parameters occurred in all patients.
在本文结束时，读者应能够：1）描述使用联合疗法治疗哮喘的患者的喉部表现；2）讨论吸入器使用引起喉部刺激的机制；3）描述减少吸入器使用引起的喉部刺激和继发性发音障碍的可能机制。
描述开始使用干粉吸入器（DPI）形式的联合皮质类固醇和支气管扩张剂治疗的患者的声音变化和喉部表现。
回顾性单病例设计。
对连续10例符合纳入标准的患者进行回顾性研究，这些患者在开始使用联合形式的哮喘药物进行控制和维持治疗后4周以上出现发音障碍，前来嗓音中心就诊。所有患者均不吸烟，既往无喉部病变诊断史。所有患者之前均接受过质子泵抑制剂治疗胃食管反流。对所有患者进行了喉部视频频闪喉镜评估。患者被要求填写一份关于其感知到的声音变化和哮喘维持治疗病史的问卷。
入选患者的发音障碍持续超过4周。这些患者之前使用传统的两药联合哮喘治疗方案，之后改用联合疗法。9例患者中有8例声带出现充血区域，表面黏膜有斑块样改变。视频频闪喉镜检查显示振动幅度降低和黏膜波传播减少。问卷显示，所有患者均在过去6个月内开始接受联合DPI治疗。
表面黏膜改变引起的发音障碍是哮喘DPI治疗的一种副作用。吸入药物和载体时的高冲击力导致颗粒在上呼吸道沉积。我们认为，通过对患者进行正确使用DPI的教育，可以将黏膜刺激程度降至最低。然而，在某些情况下，有必要恢复单独使用两种药物。所有患者均出现喉部黏膜刺激和正常振动参数恢复的情况。
