Diagnosis of vocal cord dysfunction/inducible laryngeal obstruction: An International Delphi Consensus Study

• DOI: 10.1016/j.jaci.2023.06.007
• Publication Date: 2023-06-20T06:06:11Z
• Authors: Paul Leong; Anne E. Vertigan; Mark Hew; Malcolm Baxter; Debra Phyland; James H. Hull; Thomas L. Carroll; Peter G. Gibson; Vanessa M. McDonald; Thomas Halvorsen; Hege Havstad Clemm; Maria Vollsæter; Ola Drange Røksund; Philip G. Bardin
• Keywords: Laryngeal Diseases; Airway Obstruction; Delphi Technique; Vocal Cord Dysfunction; Australia; Humans; Vocal Cords; 3. Good health

Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is characterized by breathing difficulties in association with excessive supraglottic or glottic laryngeal narrowing. The condition is common and can occur independently; however, it may also be comorbid with other disorders or mimic them. Presentations span multiple specialties and misdiagnosis or delayed diagnosis is commonplace. Group-consensus methods can efficiently generate internationally accepted diagnostic criteria and descriptions to increase clinical recognition, enhance clinical service availability, and catalyze research.We sought to establish consensus-based diagnostic criteria and methods for VCD/ILO.We performed a modified 2-round Delphi study between December 7, 2021, and March 14, 2022. The study was registered at ANZCTR (Australian New Zealand Clinical Trials Registry; ACTRN12621001520820p). In round 1, experts provided open-ended statements that were categorized, deduplicated, and amended for clarity. These were presented to experts for agreement ranking in round 2, with consensus defined as ≥70% agreement.Both rounds were completed by 47 international experts. In round 1, 1102 qualitative responses were received. Of the 200 statements presented to experts across 2 rounds, 130 (65%) reached consensus. Results were discussed at 2 international subject-specific conferences in June 2022. Experts agreed on a diagnostic definition for VCD/ILO and endorsed the concept of VCD/ILO phenotypes and clinical descriptions. The panel agreed that laryngoscopy with provocation is the gold standard for diagnosis and that ≥50% laryngeal closure on inspiration or Maat grade ≥2 define abnormal laryngeal closure indicative of VCD/ILO.This Delphi study reached consensus on multiple aspects of VCD/ILO diagnosis and can inform clinical practice and facilitate research.