LPR respiratory.pdfVIP

The Laryngoscope Lippincott Williams Wilkins, Inc. ? 2004 The American Laryngological, Rhinological and Otological Society, Inc. Respiratory Retraining of Refractory Cough and Laryngopharyngeal Reflux in Patients With Paradoxical Vocal Fold Movement Disorder Thomas Murry, PhD; Abtin Tabaee, MD; Jonathan E. Aviv, MD Objectives/Hypothesis: The objective was to de- scribe a case series of patients with refractory cough and paradoxical vocal fold movement disorder treated with respiratory retraining therapy. Study Design: Retrospective review of a case series in a ter- tiary medical care center. Methods: Five patients with laryngopharyngeal reflux were identified with re- fractory cough and paradoxical fold movement disor- der on transnasal fiberoptic laryngoscopy by a greater than 50% reduction in airway during inspira- tion. The were four women and one man (age range, 42–67 y). All patients had normal forced vital capacity and forced expiratory flow but decreased ratio of forced inspiratory volume at 0.5 seconds (FIV0.5) to forced inspiratory vital capacity (FIVC) before start- ing therapy. All patients were treated with more than 6 months of twice-daily proton pump inhibitor ther- apy with improvement in reflux symptoms but persis- tent and severe daytime cough. They were subse- quently treated with respiratory retraining therapy. Patients were asked to rate subjectively the severity of cough at the onset and conclusion of therapy. All patients underwent pulmonary function testing be- fore and after therapy. Long-term follow-up ranged from 5 to 17 months. Results: Patients received two to seven sessions of respiratory retraining therapy. The mean severity score changed from 9.2 before therapy to 1.3 after therapy. All patients subjectively de- scribed an improvement in the severity of their cough. Transnasal flexible laryngoscopy demon- strated improvement in paradoxical vocal fold move- ment, and pulmonary function testing showed im- provement in the FIV0.5/FIVC ra