Vocal Cord Dysfunction

woman with breathing difficulty

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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.

However, asthma medications have no effect on VCD. Sometimes, people undiagnosed for VCD will go to the emergency room and be treated as if they have asthma. Find out more about how VCD is diagnosed and effectively treated.

Symptoms

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.

During a VCD attack, the vocal cords will close over the airways as you inhale, making it difficult to breathe. While some air will get through, severe attacks can often lead to hyperventilation and require medical treatment.

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.

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.

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.

An increased incidence of VCD was found among World Trade Center 9/11 responders, the condition of which was attributed to the inhalation of dust and chemicals following the collapse of the twin towers.

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 symptoms. Even so, 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 definitively diagnosed, nasal endoscopy and spirometry need to be performed at the time of an attack. With that said, a presumptive diagnosis can be made based on a review of symptoms and risk factors.

Treatment

There are many treatment options for people with VCD, many of which focus on relaxation of the vocal cord muscles. Others aim to prevent triggers that lead to VCD attacks. Options include:

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

At least 25% of people with VCD will have true asthma and require treatment for both conditions, including the use of acute and chronic asthma medications.

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 you have to live with for life.

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  1. De la Hoz RE, Shobet M, Binenfeld LA, et al. Vocal Cord dysfunction in former World Trade Center (WTC) rescue and recovery workers and volunteers. Am J Indust Med. 2008 Mar;51(3):161-5. doi:10.1002/ajim.20541


Additional Reading

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