Concern: Florest Cambran used to live in a state of constant fear of strong smells such as perfume, cigarette smoke and paint
Florest Cambran used to live in a state of constant fear of strong smells such as perfume, cigarette smoke, paint or household cleaning products.
These could set off a coughing fit that would leave her struggling to breathe and often caused her to pass out.
‘Once I came home to find a corridor being painted,’ says 49-year-old Florest, a nurse from Wallington in London. ‘A cloud of fumes hit me and the next thing I remember is waking up in intensive care. I had a tube in my airway and was on a ventilator to help me breathe.’
The mother of three became nervous about leaving the house, and routinely turned down invitations. It was ‘easier to cocoon myself away’, she says.
For years, Florest was told by a series of GPs and specialists that her symptoms were down to asthma, and she was given preventer and reliever inhalers. But there were times when no amount of puffing on these would stop an attack.
Suspecting something else was going on, two years ago Florest’s respiratory consultant referred her to a specialist clinic at the Royal Brompton Hospital in Chelsea, London, where tests led to another diagnosis: irritant-induced laryngeal obstruction. Estimated to affect about 250,000 people in Britain, this is a disorder of the voice box, rather than the lungs, but its symptoms — breathlessness, coughing and wheezing — resemble asthma.
But unlike asthma, where sensitive airways become inflamed and narrow, it occurs when the muscles of the voice box, or larynx, tighten, stopping air reaching the windpipe below.
This typically happens as a reaction to environmental triggers such as perfumes, deodorants, household cleaning agents — even wine.
Another difference is that while asthma patients wheeze while breathing out, with this condition they wheeze while breathing in.
It is not generally life-threatening, but in some cases the voice box can close so tightly that insufficient oxygen reaches the brain and the patient loses consciousness.
‘We think that nerve endings in the larynx may become over-sensitised to certain scents and irritants,’ explains Dr James Hull, a consultant respiratory physician at the Royal Brompton Hospital.
‘It triggers a process where the voice box closes as a defence mechanism; it’s trying to protect the airway inappropriately,’ he says.
Diagnosis: Two years ago, she was referred to the Royal Brompton Hospital where she underwent a new diagnostic test (called a continuous laryngoscopy) and was diagnosed with irritant-induced laryngeal obstruction
Why it develops is unclear, but excess secretions from conditions such as acid reflux — where stomach acid splashes up into the gullet and throat — and persistent rhinitis [inflammation in the nose, causing nasal discharge] are thought to irritate the voice box and contribute to the over-sensitivity.
There are 5.4 million people in the UK being treated for asthma, but studies suggest some have been diagnosised wrongly.
A 2017 study in Canada, for example, found that a third of adults with an asthma diagnosis did not have any evidence of the condition.
Not all of those misdiagnosed will have irritant-induced laryngeal obstruction, but Dr Hull says that ‘because asthma and its symptoms are so common, it can be a bucket diagnosis for a variety of other conditions’.
Furthermore, some people