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Vocal cord dysfunction / inducible laryngeal obstruction – expert consensus on a controversial topic

Published: June 19, 2023

Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) refers to a condition where the larynx inappropriately closes during breathing, causing breathing difficulties. The disorder is now recognized as clinically important in many specialties including sports medicine, pulmonology, emergency medicine, allergy, pediatrics, speech pathology and otorhinolaryngology. A growing number of international guidelines recognize the importance of VCD/ILO. A key challenge for the field has been how to diagnose the disorder. In a recent issue of The Journal of Allergy and Clinical Immunology (JACI), Leong and colleagues present a large Delphi study examining how experts diagnose VCD/ILO worldwide. Delphi studies are scientifically rigorous processes that identify areas of expert agreement. This study sampled 48 international experts, and patients were involved in reviewing results. 130 statements were agreed upon.

An important area of consensus was a new diagnostic description for VCD/ILO. Experts agreed that different forms, or ‘phenotypes’ of VCD/ILO exist. Experts agreed that laryngoscopy with provocation (a factor during laryngoscopy designed to provoke laryngeal closure) is the gold standard for diagnosis. For suspected exercise-induced laryngeal obstruction, continuous laryngoscopy during exercise is the gold standard, and experts agreed on a grading system to define abnormal laryngeal closure.

For the non-exercise VCD/ILO phenotype, the requirement to identify a trigger is no longer present. Experts agreed, for the first time, on quantitative criteria on laryngeal closure in this form of the disorder. It is anticipated that these will help to standardize research and clinical practice in the field and enhance progress.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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