Two questions to prioritise laryngoscopy in suspected vocal cord dysfunction/inducible laryngeal obstruction

Extract Vocal cord dysfunction (VCD)/inducible laryngeal obstruction (ILO) is an important cause of episodic dyspnoea and cough that may mimic or coexist with asthma, contributing to diagnostic delay and inappropriate treatment 1–5. Current ERS/ELS and international consensus documents favour inducible laryngeal obstruction as the umbrella term and emphasize laryngoscopy, ideally with symptom provocation when feasible, as the reference standard 1–3. In this context, “inducible” should not be understood as referring only to external provocation, as symptoms may also occur in association with other contributing triggers or conditions, such as gastro-oesophageal reflux, post-nasal drip, cough, or frequent throat clearing 6. Symptom-based tools have nevertheless remained clinically attractive because laryngoscopy is not always immediately available. The Pittsburgh VCD Index was developed to distinguish VCD from asthma, and the VCDQ was designed for symptom monitoring rather than diagnosis 7, 8. More recently, standard symptoms and questionnaires did not reliably predict laryngoscopic VCD/ILO in a lung-disease population 9. We therefore revisited whether a deliberately ultra-brief symptom rule could still help prioritise laryngoscopy in a specialist respiratory referral cohort.