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What you need to know about

Vocal cord dysfunction

What is vocal cord dysfunction (VCD)?

  • Condition in which one or both vocal cords close abnormally when breathing in, triggering sensation similar to asthma
  • Also called paradoxical vocal fold motion
  • Occurs with asthma in 40% of all cases – which often means VCD diagnoses are missed
  • Once diagnosed, treatment can address and cure it

 

 

Symptoms

  • Shortness of breath
  • Hoarseness and/or wheezing
  • Chronic cough and/or throat clearing
  • Throat tightness
  • Air hunger (having trouble getting air in)
  • Exaggerated sighing
  • Lightheadedness or dizziness

Causes and triggers

Vocal fold closure decreases airflow during inhalation, exhalation or both – leading to asthma-like symptoms when less air flows into trachea and lungs. VCD usually involves only one trigger compared to asthma, which often involves multiple triggers. VCD episodes can be triggered suddenly or come on gradually. Common VCD triggers include:

  • Gastroesophageal reflux disease (GERD)
  • Exercise
  • Strong odors (smoke, perfume, gas, cleaning chemicals, nebulizers, chlorinated pools)
  • Infection
  • Allergens
  • Emotional stress

Diagnosis and testing

  • VCD is often diagnosed after other diseases are ruled out.
  • VCD should be considered in patients with difficult-to-treat asthma and in athletes whose exercise-induced symptoms fail to respond to therapy. Even young children can report the difference between asthma attack symptoms (difficulty exhaling) and VCD attack symptoms (primarily difficulty inhaling).
  • Most effective ways to diagnose VCD are direct laryngoscopy (scope inserted into nose to view vocal fold movement and determine abnormalities) or video stroboscopy (same procedure using video and strobe light to record movement and review frame by frame).
  • Specialist looks for abnormal movement, signs of vocal cord swelling, evidence of irritation or inflammation.

Treatment

  • Anti-reflux medications are often prescribed to eliminate complications from reflux that may contribute to vocal cord irritation.
  • Speech therapy may be recommended to teach patient breathing exercises and improved breathing techniques that increase control over reaction to triggers.
  • Relaxation and stress reduction techniques can enhance recovery.
  • For patients with both VCD and asthma, understanding differences between them helps learn when to use rescue inhalers and when to use breathing exercises.

Basic breathing exercises

The following breathing exercises should be performed during VCD episodes in a slow, calm manner (to prevent hyperventilation) until symptoms subside. Once comfortable with them, perform them before physical activity.

  • Sniff hard through nose, then breathe out through rounded lips. Repeat twice.
  • Breathe out forcefully through lips, then breathe in through nose (or rounded lips) in a relaxed manner. Repeat four times.
  • Exhale in short burst, then breathe in gently through nose (or rounded lips). Repeat four times.