Vocal Cord Dysfunction (VCD, Paradoxical Vocal Fold Motion)

Vocal Cord Dysfunction (VCD) on the surface looks and sounds like asthma.  In fact, up to 40% of “severe asthmatics” may instead have vocal cord dysfunction.  Further confusing the matter is that some patients have both asthma and VCD.  Symptoms of VCD include cough, wheeze, chest or throat discomfort and shortness of breath.  The difference between asthma and VCD is that asthma is a disease of the lower airway that responds to inhalers.  VCD is due to abnormal motion of the vocal folds due to closure of the vocal folds at the wrong time during the breathing cycle.  In classic vocal fold dysfunction the vocal cords adduct (squeeze together) during an inhalation.  Just as you are trying to take a breath in, your chest expands, the diaphragm contracts but the larynx tightens and it may feel like strangulation.  Fortunately, VCD cannot entirely close off the airway and though it feels terrible, patients with VCD usually do not have low oxygen levels.  However unnerving VCD is, it should not be life-threatening.  However, until the proper diagnosis is made, VCD may cause great anxiety.

Diagnosis of VCD:  A clue to the diagnosis starts with simply taking a good history of the patient’s symptoms (namely that the problem occurs more during breathing in and does not respond to the rescue inhaler (bronchodilator, for example, Albluterol).  A few simple tests in the office including pulmonary function testing and a video laryngosopy are usually all that is necessary.  Dr. Stadtmauer performs both of these tests in the office, usually at the first visit.  Sometimes, because the VCD only occurs during exercise which makes diagnosis more challenging.

Treatment of VCD:  This depends upon contributing factors but may include treatment for acid reflux into the throat (LPR), breathing exercises and referral to a speech therapist with expertise in this area.  It usually takes a while for the problem to improve.

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