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‘Voice Box’ Asthma – a new treatment with botulinum toxin

‘Voice Box’ Asthma – a new treatment with botulinum toxin. Prof Phil Bardin Lung and Sleep Medicine Monash University & Medical Centre Melbourne. Severe asthma is an ongoing area of medical need. Severe Asthma. Overall approximately 5-25% of asthma

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‘Voice Box’ Asthma – a new treatment with botulinum toxin

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  1. ‘Voice Box’ Asthma – a new treatment with botulinum toxin Prof Phil Bardin Lung and Sleep Medicine Monash University & Medical Centre Melbourne

  2. Severe asthma is an ongoing area of medical need

  3. Severe Asthma • Overall approximately 5-25% of asthma • Frequent hospital admissions, use 60% of health-care dollar allocated to asthma care • Usual treatment = steroid tablets with severe side-effects • Poor response to anti-inflammatory treatments – suggesting resistant inflammation – or a problem unrelated to asthma itself

  4. Very little is known about upper airway activities in severe asthma One possibility: upper airway obstruction masquerading as severe asthma

  5. Rhino-Laryngoscope

  6. Endoscopy showing voice box closure Inspiration Expiration

  7. Endoscopy: Uncomfortable Not quantifiable Poorly tolerated in many asthmatics with acute symptoms

  8. Toshiba 320-slice CT • Developed primarily for cardiac study • Scans 16 cm ‘volume’ and obviates the need to ‘stitch together’ images. • Can detect and image movement

  9. 320 x 0.5 mm detectors = 16cm coverage • Detects bigger area • Detects movement

  10. Normal voice box function

  11. Normal RATIO (VC/trachea) Inspiration Expiration Low et al, Am J Resp Crit Care Med 2011

  12. Normal Range Mean 1.5 SD Below Mean = LLN

  13. Healthy person Healthy control

  14. Asthma: voice box closure

  15. Images showing narrowed voice box Inspiration Expiration

  16. Overall: Abnormal laryngeal movement was present in 23 out of 46 asthmatics with severe asthma (50%) (None of 29 healthy persons had abnormality)

  17. Therapy for voice box asthma

  18. Results: speech therapy

  19. Results: speech therapy

  20. Botulinum toxin (Botox®) for voice box asthma • Botox is used to treat muscle cramps and spasms • Voice box asthma may be a form of spasm • Treatment may relieve the spasm and break the ‘bad habit’ • This may improve severe asthma – and possibly turn it into mild disease easy to treat

  21. Botulinum toxin (Botox®) for voice box asthma • Botox will be given by very thin needle directly into one voice box muscle • The procedure is safe and has been used frequently for another condition of voice box spasm in non-asthmatics (vocal cord dystonia)

  22. Botulinum toxin (Botox®) for voice box asthma • The planned trial has been approved by the Southern Health Ethics committee and will start soon • We hope that it will improve severe asthma – and possibly turn it into mild disease easy to treat

  23. Laryngeal dysfunction in severe asthma – it has been happening ……..

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