Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
Manchester Biomedical Research Unit, NIHR, Manchester, UK.
BMJ Open Respir Res. 2022 Jun;9(1). doi: 10.1136/bmjresp-2022-001199.
Inducible laryngeal obstruction (ILO) describes transient laryngeal closure during respiration and can cause significant morbidity. Non-pharmacological behavioural therapy is the commonly cited treatment but efficacy is largely unknown.
To synthesise the current evidence base on the effectiveness of non-pharmacological interventions used to treat adults with ILO.
Electronic databases (Medline/Embase/CINAHL/PsycINFO/AMED/CENTRAL) were systematically searched, informed by a population, intervention, comparison, outcome framework. Two reviewers independently screened a representative sample, with lead-author completion due to excellent inter-rater reliability. Data was extracted using a predefined piloted form. Methodological quality was appraised (blindly by two reviewers) using the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was performed due to heterogeneity of studies (PROSPERO registration number: CRD42020213187).
Initial searching identified 3359 records. Full-text screening occurred in 92 records and 14 studies, comprising 527 participants, were deemed eligible. All studies were low-level evidence (observational by design, with four case reports), with a high risk of bias; none contained control arms for comparison. Intervention description was inconsistently and poorly described but direction of effect was positive in 76% of outcomes measured. The majority of studies showed a reduction in symptom scores and improved direct laryngeal imaging post intervention; there was an overall reduction, 59.5%, in healthcare utilisation.
The literature is in an embryonic state and lacks robust data to truly inform on the effectiveness of non-pharmacological interventions used to treat adults with ILO. However, positive signals in the synthesis performed support non-pharmacological treatment approaches and further development is warranted.
诱导性喉阻塞 (ILO) 描述了呼吸过程中的暂时性喉关闭，可导致严重的发病率。非药物行为疗法是常用的治疗方法，但疗效在很大程度上尚不清楚。
综合目前关于非药物干预治疗成人 ILO 的有效性的证据基础。
根据人群、干预、比较、结果框架，系统地搜索电子数据库（Medline/Embase/CINAHL/PsycINFO/AMED/CENTRAL）。两名审查员独立筛选代表性样本，由于极好的评分者间可靠性，由主要作者完成。使用预定义的试点表格提取数据。使用 Joanna Briggs 研究所的批判性评估工具（盲法由两名审查员）评估方法学质量。由于研究存在异质性（PROSPERO 注册号：CRD42020213187），因此进行了叙述性综合。
初步搜索确定了 3359 条记录。92 条记录和 14 项研究进行了全文筛选，认为有 527 名参与者符合条件。所有研究均为低水平证据（设计为观察性研究，其中包括 4 份病例报告），存在高偏倚风险；没有对照臂进行比较。干预描述不一致且描述较差，但 76%的测量结果表明干预的效果是积极的。大多数研究表明，干预后症状评分和直接喉部影像学均有所改善；整体而言，医疗保健利用率降低了 59.5%。
该文献处于萌芽状态，缺乏真实反映用于治疗成人 ILO 的非药物干预有效性的可靠数据。然而，综合分析中出现的积极信号支持非药物治疗方法，进一步的发展是必要的。
