Vocal Cord Dysfunction

This syndrome causes asthma-like symptoms

Woman out of breath because of physical activity
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Vocal Cord Dysfunction (VCD) is a syndrome that causes asthma-like symptoms as a result of the abnormal closure of the vocal cords. Symptoms may include wheezing, shortness of breath, and chest or neck tightness. VCD can so closely mimic asthma that this syndrome has also been called vocal cord asthma.

Asthma medications have no effect on VCD, though. Sometimes people who don't have a diagnosis and are experiencing symptoms go to the emergency room and are treated as if they have asthma (they might be given oral corticosteroids, for instance) but do not get any symptom relief.

Find out more about how VCD is diagnosed and effectively treated. 

An Overview of VCD

Normally, the vocal cords, which sit over the airway at the voice box (larynx), open to let air move through when you take a deep breath. Then, the vocal cords close and vibrate over the airway to make a sound when you are talking. In people with VCD, the vocal cords close over the airway involuntarily with inhalation, making it extremely difficult to breathe. While this sounds dangerous, there is typically a small area at the back of the airway that is not affected, so that the person is actually getting enough oxygen during an attack.

Typically, when VCD occurs, a person will notice the sudden onset of severe symptoms like trouble breathing, wheezing, or stridor (a high-pitched noise) when inhaling. The person will probably be unable to speak or will speak only with a hoarse voice. Asthma inhalers do not help in this situation; the person may find that sitting down and taking slow, deep breaths gradually resolves the symptoms over many minutes.

Getting a Diagnosis

Clues to the diagnosis include a person who has been diagnosed as having severe asthma, yet has not responded well to typical asthma medications. The person may have had multiple emergency room visits, hospitalizations, and even endotracheal intubations as a result of their symptoms.

Even so, their asthma continues to be difficult to control.

Once VCD is suspected, pulmonary function testing (spirometry) may show evidence of VCD. The best test is for a physician to directly see the movement of the vocal cords using a nasal endoscope. Nasal endoscopy involves a tiny camera at the end of a long, thin plastic tube that's inserted into the nose and down the throat.

For VCD to be diagnosed, spirometry or nasal endoscopy needs to be performed at the time a person is actually having symptoms; otherwise, a diagnosis of VCD can be made based on the symptoms that the patient reports.

Common Causes 

The cause of VCD is not fully known or understood. Some experts think that the condition is related to stress and anxiety and may even be a symptom of a psychiatric disorder. Recently, VCD has also been attributed to gastroesophageal reflux disease (GERD) and laryngeal spasms.

Triggers of VCD

VCD seems to be triggered in various ways. For some, exercise is the only trigger, and the amount of exercise that triggers the problem can depend on the individual. For others, stress and anxiety—often during social gatherings—is a common trigger. Other people have their VCD triggered by irritants, such as GERD, or the inhalation of various environmental irritants such as strong odors or perfumes.

Available Treatments

There are many treatment options for people with VCD. These include:

  • Speech therapy
  • Breathing exercises
  • Relaxation techniques
  • Biofeedback
  • Hypnotherapy
  • Injection of vocal cords with botulism toxin (Botox)
  • Treatment of GERD
  • Tracheostomy
  • Atrovent (ipratropium bromide) inhalers to prevent exercise-induced VCD

At least 25 percent of people with VCD may also have true asthma, so in some cases, medications for asthma may also need to be used.

How Long People Have VCD

In one study, almost all of the people with VCD who were followed had symptoms for fewer than five years—and many had symptoms for no more than six months.

So VCD isn't necessarily a condition that will stay with you for life. 

Source:

Park DP, Ayres JG, McLeod DT, Mansur AH. Vocal Cord Dysfunction Treated with Long-Term Tracheostomy: 2 Case Studies. Ann Allergy Asthma Immunol. 2007; 98:591-4.

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