What is vocal cord dysfunction?

The vocal cords play an important role in breathing. They should open completely when we inhale, letting air into the lungs.

Vocal cord dysfunction (VCD) is a condition where your vocal cords close while you are trying to inhale, so that you are only able to breathe in a small amount of air. The result is similar to an asthma attack, and VCD is often misdiagnosed as asthma.

VCD usually involves sudden episodes of difficulty breathing, rather than a chronic feeling of being short of breath. VCD is not a medical condition, which means there is no pill to eliminate VCD. Usually the lungs are healthy, but your vocal cords are responding to irritating triggers that cause the vocal folds to close.

Sometimes other medical conditions can occur with VCD, and other medical conditions can contribute to VCD attacks or make VCD worse.

Other common names for VCD are paradoxical vocal fold motion (PVFM) and irritable larynx syndrome. Chronic cough is also often related to or considered part of this continuum of voice disorders.

What are some of the common symptoms?

• Throat or chest tightness
• Difficulty getting air “in”
• Feeling short of breath
• Stridor (making sound as you inhale)
• Throat closing
• Feeling of being “strangled”
• Chronic cough
• Episodic hoarseness

Who gets VCD?

Some people seem to have an overly sensitive larynx that can spasm shut in response to an irritant.

There are medical conditions which trigger VCD, such as acid reflux (GERD), upper respiratory infections, allergies, and postnasal drip. There are also other triggers -- like noxious odors, smoke, chemicals, perfumes, cold air, exercise, and stress -- that can trigger an episode of VCD.

It is possible to have asthma as well as VCD. Some athletes are prone to attacks of VCD.

How is it diagnosed?

The diagnosis of VCD usually involves a team approach. A doctor specializing in conditions which effect breathing (a pulmonologist) usually is part of this team.

Your pulmonologist may complete pulmonary function tests or spirometry. Other diagnostic tests used to rule out other disorders may include a methocholine challenge, ABG’s, bronchoscopy, and blood tests.

An ENT doctor or a pulmonologist may complete fiberoptic laryngoscopy to look inside the throat and observe your patterns of breathing. A thorough history of your symptoms and triggers will be gathered, often with the help of a speech therapist.

How is VCD treated?

Treatment consists of working with your physicians to control medical triggers of VCD.

A speech therapist who understands VCD will be key in helping you control the VCD symptoms. Speech therapy focuses on breathing techniques to get air in during an attack.

The basics include mastery of diaphragmatic (lower abdominal) breathing, reduction of upper body tension, and pursed-lip breathing. Learning relaxation techniques to manage stress also helps curb attacks.

Speech therapy also focuses on helping you identify all the factors that trigger an attack so you can prevent further attacks. It is important to remember that treatment involves following all of the recommendations from your doctor(s) and speech therapist.

Your larynx did not develop this condition overnight and therefore, it may take some time to get your larynx to stop reacting by closing up. In the meantime, you will have the “rescue” exercises to help you breathe if you have a VCD attack.

The goal is for the attacks to be eliminated completely over time. Be patient and you will get control of this condition.