Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK.
Manchester Academic Health Science Centre, Manchester, UK.
Clin Exp Allergy. 2020 Nov;50(11):1230-1237. doi: 10.1111/cea.13715. Epub 2020 Sep 6.
Inducible laryngeal obstruction (ILO) is often misdiagnosed as, or may coexist with, asthma. Identifying differences in triggering factors may assist clinicians to differentiate between the two conditions and could give mechanistic insights.
To identify and compare patient-reported triggers in ILO and asthma.
This was a two-part study. Initially, we conducted a retrospective case note review of the triggers of ILO from endoscopically confirmed ILO patients to generate a Breathlessness Triggers Survey (BrTS). Triggers were categorized as scents, environmental factors, temperature, emotions, mechanical factors and daily activities. Secondly, ILO and/or asthma patients completed the BrTS prospectively, rating the likelihood of each item triggering their symptoms using a five-point Likert scale (strongly disagree to strongly agree). Chi-square testing was performed to compare responses by cohort.
Data from 202 patients with ILO [73% female, mean (SD) age 53(16) years] were included in the case note review. For the prospective study, 38 patients with ILO only [63% females, age 57(16) years], 39 patients with asthma only [(56% female, age 53(13) years] and 12 patients with both ILO and asthma [83% female, mean age, 57 (14) years)] completed the BrTS. The triggers identified in the case note review were confirmed in the independent sample of patients with ILO and/or asthma and identified several difference in prevalence of the triggers between disease types. Mechanical factors (talking [P < .001], shouting [P = .007] and swallowing [P = .002]) were more common in the ILO cohort compared to patients with asthma. Environmental factors (pollen/flowers [P = .005] and damp air [P = .012]) were more common in asthma. There were no differences between groups in frequency of reporting scents as triggers (except for vinegar, more common in ILO, P = .019), temperature, emotions or daily activities.
There were notable differences between patient-reported triggers of ILO and asthma, which may support clinician differential diagnosis.
喉内阻塞（ILO）常被误诊为哮喘，或与哮喘同时存在。确定触发因素的差异可能有助于临床医生区分这两种疾病，并提供发病机制方面的见解。
确定并比较 ILO 和哮喘患者报告的触发因素。
这是一项两部分的研究。首先，我们对经内镜证实的 ILO 患者的病历进行回顾性病例分析，以生成呼吸困难触发因素调查（BrTS）。触发因素分为气味、环境因素、温度、情绪、机械因素和日常活动。其次，ILO 和/或哮喘患者前瞻性地完成 BrTS，使用五点 Likert 量表（强烈不同意至强烈同意）对每项触发症状的可能性进行评分。采用卡方检验比较两组的反应。
202 例 ILO 患者[73%为女性，平均（SD）年龄 53（16）岁]的病历数据被纳入回顾性病例分析。前瞻性研究中，38 例 ILO 患者（63%为女性，年龄 57（16）岁）、39 例哮喘患者（56%为女性，年龄 53（13）岁）和 12 例 ILO 和哮喘患者[83%为女性，平均年龄 57（14）岁]完成了 BrTS。在独立的 ILO 和/或哮喘患者样本中证实了病例回顾中发现的触发因素，并确定了两种疾病类型之间触发因素的流行率存在差异。机械因素（说话[P<.001]、大喊[P=.007]和吞咽[P=.002]）在 ILO 组比哮喘组更常见。环境因素（花粉/花[P=.005]和潮湿空气[P=.012]）在哮喘组更常见。两组报告气味作为触发因素的频率没有差异（除了醋，在 ILO 中更常见，P=.019）、温度、情绪或日常活动。
ILO 和哮喘患者报告的触发因素有明显差异，这可能支持临床医生进行鉴别诊断。
