B40-16 The Inpatient Burden of Vocal Cord Dysfunction on Clinical Outcomes and Resource Utilization in Adults Hospitalized With Asthma

Abstract

Asthma is a heterogeneous lower airway disease and a leading cause of hospitalization, respiratory failure, and mechanical ventilation. In refractory asthma, inpatient evaluation often prioritizes cardiopulmonary pathology, while functional upper airway disorders remain overlooked. Vocal cord dysfunction (VCD), characterized by paradoxical vocal cord adduction, can mimic or coexist with asthma, producing wheezing, dyspnea, and poor response to therapy [1, 3]. Under-diagnosis of VCD among asthmatic contributes to inappropriate corticosteroid, biologic therapy, and recurrent hospitalizations. VCD should be considered in the differential diagnosis of severe asthma often evaluation with dynamic bronchoscopy [1,2]. However, population-level data of VCD on inpatient outcomes, disparities and healthcare utilization among adults hospitalized with asthma remains limited.

We conducted a retrospective observational analysis of adult (≥18 years) asthma hospitalizations using the Healthcare Cost and Utilization Project’s National Inpatient Sample from 2018-2022. Asthma admissions with and without concurrent VCD were identified using ICD-10-CM diagnosis codes. Survey weighted multivariable regression models were used to evaluate in-hospital mortality, complications, length of stay, and total hospital charges, adjusting for demographic characteristics, socioeconomic status, payer type, and comorbidities. Out of the estimated 9.9 million adult asthma hospitalizations nationwide, approximately 38,000 (0.38%) had documented VCD. Compared with non-VCD hospitalizations, patients with VCD were more frequently female (76.7% vs 70.3%), more often White than Black (57.4% vs 24.7%), and more commonly insured by Medicare (42.9% vs 39.5%) (all P < 0.001). VCD was independently associated with increased in-hospital mortality (OR 1.42, 95% CI 1.20-1.68), mechanical ventilation (OR 5.87, 95% CI 4.76-7.24), and acute respiratory distress syndrome (OR 2.26, 95% CI 1.74-2.92). VCD was also independently associated with gastroesophageal reflux disease (OR 2.09, 95% CI 1.99-2.20), irritable bowel syndrome (OR 1.29, 95% CI 1.12-1.49), allergic rhinitis (OR 2.35, 95% CI 1.96-2.82), and anxiety (OR 2.08, 95% CI 1.97-2.18) (all P ≤ 0.001). These associations persisted after multivariable adjustment. VCD hospitalizations were additionally associated with longer mean length of stay (7.1 vs 4.7 days) and higher total hospital charges ($99,491 vs $60,847).In conclusion asthma admissions complicated by vocal cord dysfunction identify a high risk, under-recognized gaps in diagnostic stewardship and care efficiency causing adverse patient outcomes and increasing healthcare costs. Conceptualizing VCD within a multisystem airway gastrointestinal hypersensitivity spectrum, rather than as an isolated comorbidity would allow integrated inpatient and outpatient strategies including acid reflux management, and behavioral therapy to improve respiratory outcomes, limit inappropriate asthma treatment escalation, reduce resource utilization, and enhance patient-centered care.

This abstract is funded by: None