How Vocal Cord Dysfunction Is Different From Asthma

August 27, 2020

"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

What Is Vocal Cord Dysfunction?

Vocal cord dysfunction, also known as paradoxical vocal fold motion disorder, is a disorder marked by occasional episodes of vocal cord contraction, particularly while breathing in. Normally our vocal cords open to allow air to move in and out of our lungs, but with vocal cord dysfunction, the vocal cords close when we breathe in, blocking most air flow and causing shortness of breath, which is classically confused with asthma. Patients often describe the frightening sensation of suffocating. Episodes of vocal cord dysfunction mostly last minutes but can last for hours.

Vocal cord dysfunction often is brought on by exercise, but also can be triggered by irritants like smoke, postnasal drip, reflux, upper respiratory infections, or even strong odors. Sometimes a noisy inhale, called stridor, accompanies vocal cord dysfunction, compared to a wheeze when asthma patients exhale. Highly motivated young adults are most often affected, and young women are three times as likely to have vocal cord dysfunction as young men.

How Is Vocal Cord Dysfunction Treated?

Vocal cord dysfunction is different from many other breathing problems because medicines are not the main treatment for control or prevention. The main treatment for vocal cord dysfunction is speech therapy techniques that help you learn to control your vocal cords.

A speech pathologist who is trained and experienced in vocal cord dysfunction can provide instruction regarding therapeutic breathing strategies to help relax throat muscles and control the vocal cords.

Initially, the speech pathologist has the patient focus on rescue breathing to help "pull out" of an episode, but ultimately on prevention so that when a patient can stop an episode when she or she feels one coming on. Learning these techniques takes regular practice, so the patient can be ready to control the symptoms before a full-blown episode.

Education and reassurance is key. Patients need to know that vocal cord dysfunction is manageable and almost always reversible. The patient learns various exercises to engage different muscles in their face and mouth to focus attention away from the vocal cords. It’s empowering and very reassuring when patients realize they can regain control of their breathing and not panic.

Asthma vs. Vocal Cord Dysfunction: Could You Tell the Difference?

Features of asthma include:

Shortness of breath
Coughing, more so with colds, exercise, at night or with other triggers
Wheezing upon exhalation
Chest tightness
Relief from asthma rescue therapy (inhalers)

Features of vocal cord dysfunction include:

Shortness of breath
Coughing during episodes
Noisy breathing (most often high pitched whistling sound with inhalation)
Neck, throat, or upper chest tightness
Hoarse voice or difficulty speaking during or after an episode
Asthma medications don’t 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 healthcare 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.