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Asthma Vs Vocal Cord Dysfunction

Did They Have Pfts Done

Lesser-known condition with asthma-like symptoms could be vocal cord dysfunction

Neither of my friends had PFTs done when they initially messaged me, and one clearly linked her symptoms to stress. They had been on asthma medicinesone for a long time, and one for just a few monthsand had tried different things and didnt feel they were helpful at all.

Then I told them a bit about VCDand both of them had similar reactions.

Oh my God. THIS sounds like what I have!

They both went for PFTs but requested an appointment with ENT specialists to be checked for VCD. Vocal cord dysfunction, like asthma, can be tricky to diagnose because if symptoms arent happening, the impaired movement of the vocal cords may not be visible when scoped by the ENT. But both of my friends were rapidly diagnosed with vocal cord dysfunction during their first ENT visits.

What Causes Vocal Cord Dysfunction How Do You Get It

There are several reasons why you might experience a vocal cord dysfunction episode:

  • Breathing in irritants. If you inhale ammonia, dust, fumes, cleaning chemicals or smoke, you could have an episode of vocal cord dysfunction.
  • A cold or viral infection.
  • Gastroesophageal reflux disease .
  • Psychological conditions. Stress, posttraumatic stress disorder , anxiety, depression and panic attacks have all been linked to episodes of vocal cord dysfunction. Anxiety is more likely to trigger an episode in kids and teenagers than adults.
  • Rhinosinusitis . Some medications. Neuroleptic drugs like phenothiazines can trigger VCD.

What Questions Should I Ask My Healthcare Provider About Vcd

  • Do I have VCD or a subtype?
  • Whats the best treatment for me?
  • What specialist should I see?
  • Should I be on medication?
  • Do I have asthma?
  • What triggered my vocal cord dysfunction?

A note from Cleveland Clinic

If youre struggling to breathe, feel like your chest is tight and theres a lump in your throat, and traditional asthma treatments arent working, its possible that you have vocal cord dysfunction. Fortunately, after you identify the triggers and learn breathing techniques, VCD shouldnt interfere with your everyday life.

One of the most important things to remember is that you need to practice your breathing exercises whether youre in a vocal cord dysfunction episode or not. Train yourself to manage your vocal cords.

Finally, dont pause if you think you need to go to the emergency department. Its better to get treatment at the hospital than it is to wait too long and find yourself in serious trouble with asthma or another type of condition that affects your breathing.

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Dont Mistake Vocal Cord Dysfunction For Asthma

We use our vocal cords all day long without thinking about them. Most of the time they are working silently and efficiently when we breathe, speak, sing or swallow. Our vocal cords open when we breathe and close briefly when we speak, grunt while lifting something heavy or during other reflexive actions.

Vocal cord dysfunction , occurs when the vocal cords do not open correctly, causing a narrowing of the voice box that creates a sensation of reduced airflow and respiratory distressin other words, being unable to draw in a breath. For that reason, VCD is often mistaken for asthma.

How Is Vocal Cord Dysfunction Diagnosed What Tests Are Done

Do You Know the Different Types of Asthma?

Diagnosing vocal cord dysfunction is difficult because it resembles asthma. Your healthcare provider may perform a variety of tests, both to rule out asthma and other issues, and to diagnose vocal cord dysfunction. Tests may include:

  • Flow-volume loop. This test shows how air flows into your lungs and if theres blockage. Usually the expiratory loop will be normal in a patient with VCD, but the inspiratory loop will be flat. The test may be performed while youre at rest or when you’re exercising.
  • Laryngoscopy. This test uses a camera on a flexible tube to look at your vocal cords. Your nose and throat will be numbed before the tube is inserted. Your healthcare provider will have you breathe and speak, and note when the vocal cords open and close, or if they dont move at all. The test is usually done as an outpatient procedure so you dont need to stay in the hospital. During the test, you are awake, and you may be asked to talk.

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How Vocal Cord Dysfunction Is Different From Asthma

“I was diagnosed with asthma at age 13. As I got older and the level of competition increased, the “asthma” got worse and my inhalers didn’t work. I was a good runner, but couldn’t compete anymore. I couldn’t breathe while racing – it was like trying to suck air through a tiny hole. I was scared, it felt like my throat was closing. Everyone said it was my asthma and the inhalers should be working. Finally, one pulmonologist diagnosed me with vocal cord dysfunction and sent me to see a speech pathologist. After four sessions with the speech pathologist, it was like I was a new runner. I went on to break high school track records, take second in the 400 at the state competition and run for a division 1 college.” — 18-year-old Female Runner

“I took one smell of the cleaning disinfectant and started having a severe coughing fit and then couldn’t catch my breath. I was wheezing. My inhaler wasn’t working at all. I couldn’t get any air in. I thought I was going to die.” — 54-year-old Male

How To Manage Vcd

Treating asthma often requires a combination of avoiding your triggers and using medication to control the symptoms, while VCD usually responds best to speech and behavioral therapy that teaches you how to control your vocal chord reaction and relax the muscles. Your doctor may refer you to a therapist who can develop an exercise plan geared to address your specific situation. You’ll also need to identify what’s triggering your VCD. If allergies or GERD may be sparking the symptoms, taking medications to control these problems can help relieve your discomfort. Managing stress can also be helpful in keeping VCD in check. If your doctor believes that your symptoms are caused by both asthma and VCD, you’ll need to treat both problems at the same time in order to get the most relief.

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Airway Anatomy And Physiology

Knowledge of normal laryngeal anatomy and physiology will help the pharmacist understand the etiology of VCD .6 Important anatomical structures include the larynx , arytenoids, epiglottis, glottis , vocal cords, vocal ligament , mucosal fold , aryepiglottic folds , vestibular ligament , and arytenoid cartilages.14 The larynx is located in the anterior neck above the trachea.14 The vocal cords, or vocal folds, are in the midsection of the larynx and stretch horizontally from the thyroid cartilage anteriorly, attaching to the vocal process of the arytenoid cartilage posteriorly.6,14 Contraction of the thyroarytenoid, interarytenoid, and lateral cricoarytenoid muscles causes adduction of the vocal cords.14 The respiratory movements of the vocal cords are coordinated with those of the diaphragm and other muscles of the ventilator pump.15 A complex innervation of muscles and nerves causes the larynx to adduct and abduct the vocal cords.14-16 The lateral cricoarytenoid and posterior cricoarytenoid muscles and the vagus, recurrent laryngeal, and superior laryngeal nerves are involved in this process.14-16 The vocal cords begin to separate just before the diaphragmatic contraction, which is mechanically advantageous.14 Sensory fibers in the intercostal nerves can affect laryngeal movements, but the responses are complex.14 These coordinated movements result in the vocal cords moving away from the midline during inspiration and slightly toward the midline during expiration.16

How Is Vcd Diagnosed

Not All Wheezing is Asthma

Parents or guardians should seek care any time that shortness of breath or difficulty breathing limits their child from doing activities, Dr. Freedman said.

Tests can be performed to confirm diagnosis and rule out other causes.

Part of testing is to confirm that the shortness of breath or difficulty breathing is not due to asthma, as this is still the more common cause of symptoms, Dr. Freedman said. We also will assess for common triggers of laryngeal irritation, such as post-nasal drip or reflux.

Exercised-induced bronchoconstriction, commonly referred to as exercised-induced asthma, is still much more common in patients.

Vocal cord dysfunction is under-recognized as causing similar symptoms. Its also common for some people to have both asthma and vocal cord dysfunction, he said.

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Understanding The Difference Between Asthma And Vocal Cord Dysfunction

Difficulty breathing, coughing and wheezing…

At first glance, you may be thinking of asthma. However, when the above symptoms are broken down, they also align very closely with a lesser known condition: vocal cord dysfunction. Due to the overlap of symptoms between these two conditions, vocal cord dysfunction and asthma can often be confused.

Vocal Cord Dysfunction

Vocal cord dysfunction , also known as or paradoxical vocal fold movement , is the atypical closure of the vocal cords when breathing. Normally, our vocal cords are open upon inhalation to allow air flow into the lungs. However, VCD occurs when the vocal cord muscles contract during inhalation, causing a narrowing of the larynx. This contraction blocks the passage of air into the lungs. Like asthma, VCD can be triggered by irritants, exercise, and upper respiratory infections. VCD can also be triggered by post nasal drip and reflux. The symptoms of vocal cord dysfunction include: shortness of breath, trouble upon inhalation, coughing, throat clearing, throat tightness and wheezing. Diagnosing VCD can be challenging but begins with history and physical exam, followed by spirometry and laryngoscopy. Treatments for VCD include deep breathing techniques and speech therapy.


Identifying Key Differences Between Asthma and VCD

If you have any concerns or are experiencing the above symptoms, please consult a physician who can properly diagnose and treat you.

Vocal Cord Dysfunction Definition:

Vocal Cord Dysfunction can be defined as involuntary and episodic closure of the vocal folds during inspiration which leads to symptoms of dyspnea, cough, dysphonia, and stridor. Vocal Cord Dysfunction has been referred to by many different names in the literature. It is commonly referred to as paradoxical vocal fold movement or inducible laryngeal obstruction . VCD is part of the spectrum of dysfunctional larynx which includes chronic cough, muscle tension dysphonia and globus pharyngeus.

VCD usually occurs during inspiration, but may also occur during expiration. It may be accompanied by a sensation of choking and suffocating, throat or chest tightness. Symptoms are often triggered quickly and resolve quickly once the triggering stimulus is removed.

VCD should be considered when other respiratory causes for symptoms are excluded or are insufficient to explain the severity of the condition.

Differential diagnosis includes: asthma, anaphylaxis, laryngeal spasm and subglottic stenosis.

Flexible transnasal laryngoscopy

The videos below are of flexible transnasal laryngoscopy demonstrating A) normal and B) paramedian vocal folds during expiration, suggestive of VCD.

Flow volume curve

Typically shows normal expiratory flow, but the inspiratory limb of the flow volume loop may be flattened. May also indicate a reduction in FIF50 of > 20-25% .

Bronchoprovocation tests
320-slice computed tomography larynx

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What Are The Symptoms Of Vcd

VCD can feel like breathing through a straw. Breathing in through closed vocal cords makes a high-pitched whistling sound. Other common symptoms include:

  • Feeling like youre choking or suffocating
  • Feeling like you have a lump in your throat
  • Frequent coughing or throat clearing
  • Shortness of breath
  • Tightness in the throat or chest

VCD is not life-threatening, but a severe asthma attack or anaphylaxis can be.

Is Vocal Cord Dysfunction Life

Asthma in adolescents: often overlooked, not to be forgotten

Dont hesitate to go to the emergency department if youre having trouble breathing. But, its likely that tests will show youre getting enough oxygen even though it doesnt feel like it. VCD can feel life-threatening, but it actually isnt.

Most people have VCD episodes only once in a while, with mild or minor symptoms. Others have episodes that are severe or occur more frequently.

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Exercise As A Trigger

Exertional VCD can be caused by maximal exercise or athletic competitions but can also be seen during routine exercise . Exercise-induced VCD can be seen in many patients who are highly competitive, in elite athletes, and in active duty military personnel who are required to exercise regularly. Exercise was initially recognized as a cause of VCD in 1984 in a 33-year-old female competitive runner who developed wheezing during exercise. She was treated for 10 years for exercise-induced asthma, but upon further evaluation her methacholine challenge testing was negative and her post exercise flow-volume loops showed characteristic flattening of the inspiratory limb . In 1996, McFadden described seven elite athletes who reported a choking sensation during exercise but had normal baseline pulmonary function testing and negative bronchoprovocation testing. On spirometry they had the characteristic flattening of the post exercise flow-volume loop . A study of active duty military patients with exertional dyspnea found that 12 % of the patients had VCD triggered by exercise .

Experts Explain How Vcd May Be Cause For Respiratory Distress In Your Child

Wheezing, coughing and the struggle to catch a single breath.

Sounds like asthma, right?

But there may be another cause for respiratory distress in your child: vocal cord dysfunction.

Asthma and vocal cord dysfunction seemingly show the same symptoms, especially in adolescents. But whats the difference between them?

Cook Childrens Emergency Department sees an average of 13,000 children each year exhibiting wheezing and difficulty breathing. The similarity of symptoms between asthma and vocal cord dysfunction may be difficult to differentiate to the eye so its important to note the small distinctions.

Asthma and VCD are quite different even though some of the symptoms can overlap,Corwin Warmink, M.D., medical director of Emergency Services at Cook Childrens said. VCD causes difficulty breathing in compared to asthma, which makes it more difficult to breathe out. They also sound different when using a stethoscope to examine a patient.

Unlike vocal cord dysfunction, asthma is an immune response when the body is exposed to various triggers, such as air pollutants, physical activity and airborne particles like pollen and pet dander. When triggered, the bronchial muscles in the airways constrict and the sudden obstruction causes the reaction of an asthma attack.

You may be experiencing an asthma attack if your symptoms include:

Tightness in the chest

Coughing and wheezing

Excess mucus

You may be experiencing vocal cord dysfunction if your symptoms include:

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Your Health Your Community Your Home

Many young athletes are diagnosed with exercise-induced asthma but may, in fact, have vocal cord dysfunction. The problem? It is often difficult to differentiate between the two.

There are multiple irritants in the air that can trigger breathing problems in young athletes: pollen and airborne irritants, chlorine in pools, and nitrogen oxides, which are used on resurfacing ice rinks.

Symptoms of vocal cord dysfunction are similar to those of exercise- induced asthma, with shortness of breath, chest tightness and cough. However, the cough of vocal cord dysfunction tends to have a seal-like barking quality, and the athlete may complain of throat tightness and changes in the pitch of their voice. This is not present in exercise-induced asthma. Color changes of the skin may also be noted in vocal cord dysfunctionpaleness or redness. In asthma, blue or purplish discoloration can be present.

Vocal cord dysfunction has an abrupt onset and resolution of symptoms, whereas exercise-induced asthma requires 5-10 minutes of exercise and persists for 30-60 minutes without treatment. Pulmonary function testing will be normal in vocal cord dysfunction patients, while in exercise-induced asthma athletes the testing will typically reveal underlying asthma.

Asthma Vs Vocal Cord Dysfunction: Could You Tell The Difference

Lesser-known condition with asthma-like symptoms could be vocal cord dysfunction

Features of asthma include:

  • Coughing, more so with colds, exercise, at night or with other triggers
  • Wheezing upon exhalation
  • Relief from asthma rescue therapy

Features of vocal cord dysfunction include:

  • Shortness of breath
  • Noisy breathing
  • Neck, throat, or upper chest tightness
  • Hoarse voice or difficulty speaking during or after an episode
  • Asthma medications dont ease symptoms

It’s important to note that asthma and vocal cord dysfunction can coexist, making diagnosis more difficult. If you or someone you know suspects vocal cord dysfunction, tell your health care provider, who may then refer to a pulmonologist to check your breathing or a ears, nose and throat specialist to check the vocal cords. Ultimately, you will need to find a speech pathologist who has experience and training with vocal cord dysfunction.

Vocal cord dysfunction is very real and can sadly go undiagnosed. By increasing vocal cord dysfunction education, we can help increase awareness. Many patients come to speech therapy because they saw a poster about vocal cord dysfunction or a friend of a friend had VCD and told them to look into it. Be that friend.

Kelly Manuszak is a speech-language pathologist at UH St. John Medical Center.

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How Is Vcd Treated

Beyond treating an underlying throat irritation such as gastroesophageal reflux disease , there is no specific medication available to treat VCD. However, many patients are referred to a speech pathologist.

A speech pathologist can help VCD patients learn to create muscle memory in the larynx to normalize breathing, especially during physical activity. For example, athletes with VCD must learn to breathe with their jaw relaxed and mouth open, using small, rapid inhalations and then exhaling through pursed lips.

Vocal Cord Dysfunction Vs Asthma

Vocal cord dysfunction, which may also be called paradoxical vocal ford motion , can present a lot like asthma, except the symptoms stem from the vocal cords in your throat, rather than your lungs.1 The symptoms that can mimic asthma include chest tightness, shortness of breath that comes and goes, and chronic cough.1

As opposed to asthma, though, which generally affects exhalation, people with vocal cord dysfunction will have difficulty getting air IN and noisy inhalationrather than wheezing when breathing out, for example.1 They may also experience feelings like their throat is closing or that they are being strangled,” inability to speak, or voice changes .

Like asthma, VCD symptoms may start after exposure to triggers, which can include chemical irritants or fumes, exercise, postnasal drip or allergies, and acid reflux.1 Different to asthma, symptoms may also be triggered by voice overuse, coughing, and strong emotions.

So, we can see how it is easy for a doctor to misdiagnose asthma as VCD, as many doctorsunless they specialize in otolaryngology are much more familiar with asthma than VCD! A big clue can be effectiveness of treatment like bronchodilators.

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