Vocal cord dysfunction (VCD) is a term that refers to inappropriate adduction of the vocal cords during inhalation and sometimes exhalation. It is a functional disorder that serves as an important mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underappreciated and misdiagnosed in clinical practice. Recognition of vocal cord dysfunction in patients with asthma-type symptoms is essential since missing this diagnosis can be a barrier to adequately treating patients with uncontrolled respiratory symptoms. Although symptoms often mimic asthma, the two conditions have certain distinct clinical features and demonstrate specific findings on diagnostic studies, which can serve to differentiate the two conditions. Moreover, management of vocal cord dysfunction should be directed at minimizing known triggers and initiating speech therapy, thereby minimizing use of unnecessary asthma medications. This review article describes key clinical features, important physical exam findings and commonly reported triggers in patients with vocal cord dysfunction. Additionally, this article discusses useful diagnostic studies to identify patients with vocal cord dysfunction and current management options for such patients.

Background Despite the increased identification of specific antibody deficiency (SAD) in CRS, little is known about the relationship of SAD severity and the severity and co-morbidities of CRS. The prevalence of an impaired antibody response in the general population is also unknown. Objective To determine if the SAD severity stratification applies to real-life data of CRS patients Methods An electronic health record database was utilized to identify CRS patients evaluated for humoral immunodeficiency with quantitative immunoglobulins and Streptococcus pneumoniae antibody titers pre- and post-pneumococcal vaccine. SAD severity was defined, according to the guidelines, based on the numbers of titers ≥1.3 μg/dL post-vaccination: severe (≤2 serotypes), moderate (3–6 serotypes), and mild (7–10 serotypes). Co-morbidities and therapeutic response were assessed. Prevalence of an impaired antibody response in a normal population was assessed. Results 24% of the CRS patients evaluated for immunodeficiency had SAD while 11% of a normal population had an impaired immune response to polysaccharide vaccination (p<0.05). When evaluated by the practice parameters definition, 239/595 (40%) met the definition of SAD. Twenty-four (10%) had severe SAD, 120 (50%) had moderate SAD, and 95 (40%) had mild SAD. Patients with moderate to severe SAD had worse asthma, a greater likelihood of pneumonia, and more antibiotic courses in the two years post-vaccination than patients with mild SAD. Conclusion This study provides real world data supporting stratification of SAD by severity, demonstrating a significant increase in the co-morbid severity of asthma and infections in CRS patients with moderate to severe SAD compared to those with mild SAD and those without SAD.

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In order to evaluate comorbidity of type I allergic disorders in patients with Rheumatoid Arthritis (RA), we studied their morbidity of allergic disease and prevalence of sensitivity to some of the important inhaled allergens in Japan. METHODS: In 99 outpatients with RA, males 20/females 79, average age 65613 Y-O, we checked their allergic history and symptoms by questionnaire and examined their serum IgE levels, which were HD-Mite (HDM), Japanese Cedar (JC), Orchard Grass (OG). All of them consented to our study. Moreover, from June to October in 2013 our hospital used 179 middle aged employees without RA as a control group, males 51/females 128 and average 4868 Y-O, studying the same data as the RA patients. RESULTS: Allergic history and/or symptoms of RA patients were Allergic Rhinitis and/or Pollinosis (AR/P) 30.3%, Bronchial Asthma 8.1%, Atopic dermatitis 2% and Urticaria 11.1%. Those of the control group were, respectively, 31.3%, 3.9%, 3.4% and 4.4%. In RA patients the percentage of AR/P was almost the same as the control group. On the other hand positive sensitivity (over class 2) to the inhaled allergens in RA patients was HDM 15.2%, JC 27.3% and OG 11.1%. In the Control group it was, respectively, 40.2%, 50.5% and 13.4%. The sensitivity rate of HDM and JC was significantly lower (p<0.001) in RA patients than in the control group. CONCLUSIONS: RA patients had a lower sensitivity to HDM and JC antigens than the control group but had the same positive allergic history/ symptoms as the control group.

The management of Duchenne muscular dystrophy is a difficult subject with various approaches taken by different centres throughout the world. In a centre for handicapped children in Western Australia a centre‐based programme of active management has been practised by a multidisciplinary team over the past twenty years (1961‐1981). To analyse its efficacy the records of 46 boys were examined for length of assisted ambulation, and the ages at which the onset of scoliosis and death occurred. Longevity and assisted ambulation is greater than generally reported and the attitude of boys in their twenties who have experienced the programme is favourabie. its success is dependent on ali the staff invoived providing motivation, counseliing and anticipatory guidance.