ORCID Profile
0000-0002-9881-9895
Current Organisations
The University of Auckland
,
Monash Health
,
The Alfred Hospital
,
Austin Health
,
Monash University School of Public Health and Preventive Medicine
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Publisher: Wiley
Date: 27-06-2018
DOI: 10.1111/CEA.13185
Abstract: Inducible laryngeal obstruction, an induced, inappropriate narrowing of the larynx, leading to symptomatic upper airway obstruction, can coexist with asthma. Accurate classification has been challenging because of overlapping symptoms and the absence of sensitive diagnostic criteria for either condition. To evaluate patients with concomitant clinical suspicion for inducible laryngeal obstruction and asthma. We used a multidisciplinary protocol incorporating objective diagnostic criteria to determine whether asthma, inducible laryngeal obstruction, both, or neither diagnosis was present. Consecutive patients were prospectively assessed by a laryngologist, speech pathologist and respiratory physician. Inducible laryngeal obstruction was diagnosed by visualizing paradoxical vocal fold motion either at baseline or following mannitol provocation. Asthma was diagnosed by physician assessment with objective variable airflow obstruction. Validated questionnaires for laryngeal dysfunction and relevant comorbidities were administered. Of 69 patients, 15 had asthma alone, 11 had inducible laryngeal obstruction alone and 14 had neither objectively demonstrated. Twenty-nine patients had both diagnoses. In 19 patients, inducible laryngeal obstruction was only seen following provocation. Among patients with inducible laryngeal obstruction, chest tightness was more frequent with concurrent asthma. Among patients with asthma, stridor was more frequent with concurrent inducible laryngeal obstruction. Cough was more frequently found in asthma alone, whereas difficulty with inspiration and symptoms triggered by psychological stress were more frequently found in inducible laryngeal obstruction alone. Patients with asthma alone had greater airflow obstruction. Relevant comorbidities were frequent (rhinitis in 85%, gastro-oesophageal reflux in 65%), and questionnaire scores for laryngeal dysfunction were abnormal. However, neither comorbidities nor questionnaires differentiated patients with or without inducible laryngeal obstruction. In this cohort with suspected inducible laryngeal obstruction and asthma, 42% had objective evidence of both conditions. Clinical assessment, questionnaire scores and comorbidity burden were not sufficiently discriminatory for diagnosis, highlighting the necessity of objective diagnostic testing.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.RMED.2017.10.012
Abstract: The Melbourne thunderstorm asthma epidemic in November 2016 was unprecedented in scale and impact. We systematically reviewed our hospital's patients with thunderstorm asthma to identify key risk factors. Of 85 adult patients assessed, the majority (60%) had no prior diagnosis of asthma. However, allergic rhinitis during the grass pollen season was almost universal (99%), as were ryegrass pollen sensitization (100%) and exposure to the outdoor environment during the thunderstorm (94%). Airborne pollen levels on the thunderstorm day were extreme. We conclude that ryegrass pollen sensitization, clinical allergic rhinitis, and acute allergen exposure constitute a risk-factor 'trifecta' for thunderstorm asthma.
Publisher: Wiley
Date: 07-10-2021
DOI: 10.1111/RESP.14165
Abstract: Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio‐recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k‐means cluster analysis. Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity ( p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score ( r = −0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female‐predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender‐balanced cluster with lower cough frequency and normal laryngeal sensitivity. Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 25-08-2023
DOI: 10.1111/ALL.15867
Abstract: Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission. This observational study included 453 severe asthma patients (41% male mean age ± SD 55.7 ± 14.7 years) from two real‐world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5‐item Asthma Control Questionnaire (ACQ‐5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post‐bronchodilator FEV1 ≥80%) or stabilization (post‐bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut‐offs of ACQ‐5/FEV1 scores. The predictors of clinical remission were identified. 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission. Biologic treatment with mepolizumab or omalizumab for severe asthma‐induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.
Publisher: Wiley
Date: 27-03-2023
DOI: 10.1111/ALL.15719
Abstract: Multidisciplinary systematic assessment improves outcomes in difficult‐to‐treat asthma, but without clear response predictors. Using a treatable‐traits framework, we stratified patients by trait profile, examining clinical impact and treatment responsiveness to systematic assessment. We performed latent class analysis using 12 traits on difficult‐to‐treat asthma patients undergoing systematic assessment at our institution. We examined Asthma Control Questionnaire (ACQ‐6) and Asthma Quality of Life Questionnaire (AQLQ) scores, FEV 1 , exacerbation frequency, and maintenance oral corticosteroid (mOCS) dose, at baseline and following systematic assessment. Among 241 patients, two airway‐centric profiles were characterized by early‐onset with allergic rhinitis ( n = 46) and adult onset with eosinophilia/chronic rhinosinusitis ( n = 60), respectively, with minimal comorbid or psychosocial traits three non‐airway‐centric profiles exhibited either comorbid (obesity, vocal cord dysfunction, dysfunctional breathing) dominance ( n = 51), psychosocial (anxiety, depression, smoking, unemployment) dominance ( n = 72), or multi‐domain impairment ( n = 12). Compared to airway‐centric profiles, non‐airway‐centric profiles had worse baseline ACQ‐6 (2.7 vs. 2.2, p .001) and AQLQ (3.8 vs. 4.5, p .001) scores. Following systematic assessment, the cohort showed overall improvements across all outcomes. However, airway‐centric profiles had more FEV 1 improvement (5.6% vs. 2.2% predicted, p .05) while non‐airway‐centric profiles trended to greater exacerbation reduction (1.7 vs. 1.0, p = .07) mOCS dose reduction was similar (3.1 mg vs. 3.5 mg, p = .782). Distinct trait profiles in difficult‐to‐treat asthma are associated with different clinical outcomes and treatment responsiveness to systematic assessment. These findings yield clinical and mechanistic insights into difficult‐to‐treat asthma, offer a conceptual framework to address disease heterogeneity, and highlight areas responsive to targeted intervention.
Publisher: Wiley
Date: 10-05-2022
DOI: 10.1111/CEA.14156
Location: Australia
No related grants have been discovered for Joy Lee.