title: Vocal cord dysfunction diagnosis may be improved by a screening check list.
abstract: BACKGROUND
  Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD.
  
  
  METHODS
  A prospective observational study involving 80 patients aged ≥18 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer "yes" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list.
  
  
  RESULTS
  The proportion of affirmative answers to the question "Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable "4 or more affirmative answers" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022).
  
  
  CONCLUSIONS
  A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
authors.affiliation: Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
authors.forename: Lucia Helena Eduardo
authors.initials: LHE
authors.lastname: Pinto
authors.affiliation: Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil. Electronic address: marcelovivoloaun@gmail.com.
authors.forename: Marcelo Vivolo
authors.initials: MV
authors.lastname: Aun
authors.affiliation: Department of Pulmonology, University of São Paulo, São Paulo, Brazil.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cukier-Blaj
authors.affiliation: Department of Pulmonology, University of São Paulo, São Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.affiliation: Department of Pulmonology, University of São Paulo, São Paulo, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.affiliation: Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.affiliation: Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
authors.forename: Rosana Câmara
authors.initials: RC
authors.lastname: Agondi
authors.affiliation: Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Giavina-Bianchi
mesh_terms: D000328:Adult; D000368:Aged; D057189:Checklist / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D064706:Vocal Cord Dysfunction / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: Airflow limitation; Asthma; Asthma attack; Lung function tests; Questionnaire