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The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators., (© 2020 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Background and Objective: Abnormal vocal cord movement may coexist with asthma and cause additional upper/middle airway obstruction. The condition may be a form of muscular dystonia that could contribute to asthma resistant to optimised treatments. Botulinum toxin causes temporary paralysis of muscle and may be an effective local treatment that improves asthma control., Methods: In an observational study, we evaluated the benefits of unilateral vocal cord injection with botulinum toxin in 11 patients (total 24 injections). Subjects had asthma resistant to optimised treatment and abnormal vocal cord movement. Responses after botulinum toxin treatment were assessed using asthma control test (ACT) scores, vocal cord narrowing quantified by computerised tomography (CT) of the larynx and spirometry. Side-effects were recorded., Results: ACT scores improved overall (9.1 ± 2.4 before and 13.5 ± 4.5 after treatment; difference 4.4 ± 4.2; P < 0.001). There was also an improvement in airway size on CT larynx (time below lower limit of normal at baseline 39.4 ± 37.63% and improved to 17.6 ± 25.6% after injection; P = 0.032). Spirometry was not altered. One patient experienced an asthma exacerbation but overall side-effects were moderate, chiefly dysphonia and dysphagia., Conclusions: Although a placebo effect cannot be ruled out, local injection of botulinum toxin may be an effective treatment for intractable asthma associated with abnormal vocal cord movement. Further mechanistic studies and a double-blind randomised controlled trial of botulinum toxin treatment are merited., (© 2014 Asian Pacific Society of Respirology.)

Background and Objective: Vocal cord dysfunction (VCD) often masquerades as asthma and reports have suggested that up to 30% of patients with asthma may have coexistent VCD. Diagnosis of VCD is difficult, in part because it involves laryngoscopy which has practical constraints, and there is need for rapid non-invasive diagnosis. High speed 320-slice volume CT demonstrates laryngeal function during inspiration and expiration and may be useful in suspected VCD., Methods: Endoscopy and high resolution 320-slice dynamic volume CT were used to examine and compare laryngeal anatomy and movement in a case of subglottic stenosis and in a patient with confirmed VCD. Nine asthmatics with ongoing symptoms and suspected VCD also underwent 320-slice dynamic volume CT. Tracheal and laryngeal anatomy and movement were evaluated and luminal areas were measured. Reductions in vocal cord luminal area >40%, lasting for >70% duration of inspiration/expiration, were judged to be consistent with VCD., Results: Studies of subglottic tracheal stenosis validated anatomical similarities between endoscopy and CT images. Endoscopy and 320-slice volume CT also provided comparable dynamic images in a patient with confirmed VCD. A further nine patients with a history of severe asthma and suspected VCD were studied using CT. Four patients had evidence of VCD and the median reduction of luminal area during expiration was 78.2% (range 48.2-92.5%) compared with 10.4% (range 4.7-30%) in the five patients without VCD. Patients with VCD had no distinguishing clinical characteristics., Conclusions: Dynamic volume CT provided explicit images of the larynx, distinguished function of the vocal cords during the respiratory cycle and could identify putative VCD. The technique will potentially provide a simple, non-invasive investigation to identify laryngeal dysfunction, permitting improved management of asthma.