Skip to main content

Study of voice disorders in patients with bronchial asthma and chronic obstructive pulmonary disease

Abstract

Background

Chronic obstructive pulmonary disease (COPD) and bronchial asthma are known to cause adverse effects on voice, which might affect the quality of life of an individual.

Aim

The study was designed to study the voice disorders in patients with COPD and bronchial asthma and its relation to disease severity and medication.

Patients and methods

Totally, 60 patients were recruited: 30 stable bronchial asthma patients and 30 stable COPD patients. All participants underwent spirometry and study of voice parameters using auditory perceptual assessment, videolaryngostroboscopy system, voice recording, and acoustic analysis.

Results

Impaired voice quality and various grades of dysphonia were detected in the COPD group in 30% by means of auditory perceptual assessment; structural changes in the vocal folds (diffuse congestion, unhealthy mucosa, and edema) were detected in 36.6%. In the bronchial asthma group, impaired voice quality and various grades of dysphonia were detected in 16.7% and structural changes were detected in 20% of them, whereas acoustic analysis showed a highly significant increase in jitter and shimmer and decreased harmonic-to-noise ratio in 100% of patients of both groups. These changes were greater in metered dose inhaler users than in dry-powder inhaler users. In the bronchial asthma group, fluticasone propionate users had a significantly decreased harmonic-to-noise ratio compared with beclomethasone dipropionate and budesonide users, as well as the least pitch and highest shimmer and jitter. A significant statistical correlation was found between ipratropium inhalation usage and increased shimmer in the COPD group. There was a highly significant correlation between spirometric severity and both grade of dysphonia and character of voice in bronchial asthma patients.

Conclusion

All COPD and bronchial asthma patients had dysphonia, either due to organic causes or due to functional causes. Voice changes were directly correlated with degree of severity and fluticasone propionate inhalation use in bronchial asthma patients, and with ipratropium bromide inhalation in the COPD group.

References

  1. Cassiani RA, Aguiar-Ricz L, Santos C, Martinez J. Glottal competence in COPD. Audiol Commun Res 2013; 18:149–154.

    Article  Google Scholar 

  2. Shastry A, Balasubramanium RK. Acoustic and perceptual analysis of voice in individuals with chronic obstructive pulmonary disease. Proceedings of 43rd Annual Convention of Indian Speech and Hearing Association (ISHCON 46); February 79 2014, Kochi, Kerala, India. [Last accessed 2014 Feb 7].

  3. Buffels J, Degryse J, Decramer M, Heyrman J. Spirometry and smoking cessation advice in general practice: a randomized clinical trial, Respir Med 2006; 100:2012–2017.

  4. Kim S, Mon J, Chung S, Lee H. A short-term investigation of dysphonia in asthmatic patients using inhaled budesonide. J Voice 2011; 25:88–93.

    Article  Google Scholar 

  5. Dworkin J. Laryngitis: types, causes, and treatments. Otolaryngol Clin North Am 2008; 41:419–436.

    Article  Google Scholar 

  6. Menvielle G, Luce D, Goldberg P, Bugel I, Leclerc A. Smoking, alcohol drinking and cancer risk for various sites of the larynx and hypopharynx: a case-control study in France. Eur J Cancer Prev 2004; 13:165–172.

    CAS  Article  Google Scholar 

  7. Global Initiative for Asthma. Global strategy for asthma management and prevention; 2016. Available at: http://www.ginasthma.org. [Accesed May 2016].

  8. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2016. Available at: Http//Www.Goldcopd.Org/ [Accesed May 2016].

  9. American Thoracic Society/European Respiratory Society Task Force. Standardization of spirometry: Eur Resp J 2005; 26:319–338.

  10. Kotby NM. Clinical vocology. Egyptian Society Of Phoniatrics and Logopedics; 2016. 15–30

  11. Behlau MS, Gama AC. Study of constancy of acoustic measurements of prolonged vowels and Consecutive trials in women without voice complaints and in women with dysphonia Ana Cristina Côrtes Gama 1, Mara Suzana Behlau. Revsocbrasfonoaudiol 2009; 14:8–14.

    Google Scholar 

  12. Darweesh E, Saleh M, Elkholy A, Elassal N The effect of chronic obstructuve pulmonary diseases and bronchial asthma on the larynx. Cairo: Ain Shams University; 2006.

  13. Jeffery PK. Structural and inflammatory changes in COPD: acomparison with asthma. Thorax 1998; 53:129–136.

    CAS  Article  Google Scholar 

  14. Fabbri L, Coggo Al, Cosmo P. Asthma diagnosis Chapter 6 In: Byme PO, Thomson NC editors. Adults in manual of asthma management. UK: 1997. 83–102.

  15. Paerson MG, Claverley PM. Clinical and laboratory assessment. In: Claverley P, Pride N. Chronic obstructive pulmonary disease. London: Chapman and Hall l; 1996. 310–322

  16. Kotby NM. Voice disorders, recent diagnostic advances. Egypt J Otolaryngol 1986; 3:89.

    Google Scholar 

  17. Lavy J, Wood G, Rubin J. Dysphonia associated with inhaled steroids. J Voice 2000; 14:581–588.

    CAS  Article  Google Scholar 

  18. Acharya R, Anuradha S, Balasubramanium R. Voice related quality of life in individuals with chronic obstructive pulmonary disease. Int J Med Res Health Sci 2014; 4:110–117.

    Google Scholar 

  19. Santos KW, Echeveste SS, Vidor DC Association between lung function and vocal affections arising from tobacco consumption. Int Arch Otorhinolaryngol 2014; 18:11–15.

  20. Damborenea TaJada J, Fernandez Liesa R, Llorente A, Naya G, Marín G, Rueda G, et al. The effect of tobacco consumption on acoustic voice analysis (Spanish). Acta Otorrinolaringol Esp 1999; 50: 448–452.

    CAS  PubMed  Google Scholar 

  21. El-Maghraby A, Mohamed E. Voice changes in patients with COPD. Egypt J Chest Dis Tuberc 2014; 63:561–567.

    Article  Google Scholar 

  22. Muzeyyen D, Emel E, Ismail K. Subjective and objective evaluation of the voice quality in patients with asthma. J Voice 2005; 10:1016.

    Google Scholar 

  23. Viveka LA, Lucyna S, Marika H, Lena S. Vocal function in relation to inhalatory steroid therapy in patients with asthma. J Voice 2002; XX:60–72.

  24. Eva ZO, Ihre EI, Hammarberg B. Voice problems as side effects of inhaled corticosteroids in asthma patients – a prevalence study. J Voice 2004; 18:403–414.

    Article  Google Scholar 

  25. Williams AJ, Baghat MS, Stableforth DE. Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality. Thorax 1983; 38:813–821.

    CAS  Article  Google Scholar 

  26. Bhalla RK, Taylor W, Jones AS. The inflammation produced by corticosteroid inhalers in the pharynx in asthmatics. Clin Otolaryngol 2008; 33:581–586.

    CAS  Article  Google Scholar 

  27. Selroos O, Backman R, Forsen KO. Local side effects during 4-year treatment with inhaled corticosteroids: a comparison between pressurized metered-dose inhalers and turbohaler. Allergy 1994; 49:888–890.

    CAS  Article  Google Scholar 

  28. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest 2004; 126:213–219.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shymaa E. Mohammed MSc.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Saeed, A.M., Riad, N.M., Osman, N.M. et al. Study of voice disorders in patients with bronchial asthma and chronic obstructive pulmonary disease. Egypt J Bronchol 12, 20–26 (2018). https://doi.org/10.4103/ejb.ejb_34_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_34_17

Key words

  • bronchial asthma
  • COPD
  • voice changes