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Vocal Cord Dysfunction

Vocal Cord Asthma

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Updated April 23, 2014

Updated April 23, 2014

What is Vocal Cord Dysfunction?

Vocal Cord Dysfunction (VCD) is a syndrome that causes asthma-like symptoms as a result of abnormal closure of the vocal cords. Symptoms may include "wheezing," shortness of breath, and chest or neck tightness. VCD can closely mimic asthma, so much so that this syndrome has also been called vocal cord asthma. Asthma medications have no effect on VCD, so people with this condition may have been to the emergency room many times and given asthma medications, including oral corticosteroids, without relief of their symptoms.

What Happens During Vocal Cord Dysfunction?

Normally, the vocal cords, which sit over the airway at the voice box, or 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 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 and wheezing, or stridor, when inhaling. The person will probably be unable to speak, or speak only with a hoarse voice, since the vocal cords are closed over the airway. Asthma inhalers do not help; the person may find that sitting down and taking slow, deep breaths gradually resolves the symptoms over many minutes.

How is Vocal Cord Dysfunction Diagnosed?

First, a physician must be suspicious of this condition. 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, a diagnosis can usually be made in people with this condition. Pulmonary function testing, or 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, 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.

What Causes Vocal Cord Dysfunction?

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

What Triggers Vocal Cord Dysfunction?

VCD seems to be triggered in various ways. Some people with VCD have exercise as the only trigger for their symptoms. The amount of exercise needed to trigger the VCD may depend on the individual. In other people with VCD, stress and anxiety, particularly in social situations, is a common trigger for VCD. Other people have their VCD triggered by irritants, such as GERD, or the inhalation of various environmental irritants such as strong odors or perfumes.

How is Vocal Cord Dysfunction Treated?

A wide array of treatment options has been tried 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
Since a significant percentage (25% or more) of people with VCD may also have true asthma, medications for asthma may also need to be used.

How Long Does Vocal Cord Dysfunction Last?

In one study, almost all people followed with a diagnosis of VCD had complete disappearance of their symptoms with a five-year time frame, with many of these people having symptoms for a total of 6 months or less.

Want to keep learning? Find out what to do if you’ve recently been diagnosed with asthma.

Sources:

Doshi DR, Weinberger MM. Long-Term Outcome of Vocal Cord Dysfunction. Ann Allergy Asthma Immunol. 2006; 96:794-9.

O’Connell M. Vocal Cord Dysfunction: Ready for Prime Time? Ann Allergy Asthma Immunol. 2006; 96:762-3.

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.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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