What is vocal cord dysfunction (VCD)?

The vocal cords play an important role in breathing. Our vocal folds are the gateway to our lungs. They should open when we inhale, allowing air to flow freely into the lungs.

Vocal cord dysfunction (VCD) is a condition where, episodically, your vocal cords close or partially 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 are no medications to eliminate VCD. However, VCD is often triggered by certain medical conditions, such as reflux or postnasal drip, so medications may be used to control the triggers for VCD.

VCD occurs when the vocal cords have a number of medical irritants to the larynx (voice box), environmental exposure to irritants, significant stress, and many other factors. The larynx and vocal cords essentially become “extra-sensitive” and often people will begin to experience more frequent episodes if the appropriate treatment strategies are not implemented.

Although VCD is not dangerous, the symptoms can be quite scary for patients and for people who observe these episodes. Accurate diagnosis is important for proper treatment and for helping patients to understand how they can control the breathing "attack."

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 common VCD symptoms?

The symptoms below are typically episodic symptoms related to VCD; they are not often constant.

• Throat or chest tightness
• Difficulty getting air “in”
• Feeling of throat closing
• Feeling of being “strangled”
• Intermittent shortness of breath
• Noisy inhalation (stridor)
• Chronic cough

Keep in mind that these symptoms can occur with other medical conditions, so accurate diagnosis is important.

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. Some athletes are prone to attacks of VCD.

Sometimes medications to treat these conditions can further aggravate VCD, such as certain asthma inhalers (please do not stop taking any medication unless it is directed by your physician). Certain medications, such as antihistamines for allergies, can provide a drying effect to the mucus membranes, which can further cause the vocal cords to be irritated or hypersensitive.

How is VCD 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 methacholine 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.

If you are not having a "breathing attack" when the laryngoscopy is performed, the doctor or speech pathologist will likely see a normal or near-normal exam. This does not necessarily indicate that you do not have VCD. A thorough history of your symptoms and triggers will be gathered, often with the help of a speech therapist.

Your breathing symptoms and patterns along with your medical work-up is essential in determining whether VCD is at least a component of your breathing problem. A person can have both asthma and VCD, so a diagnosis of VCD does not rule out other serious medical conditions.

How is VCD treated?

Treatment consists of working with your physicians to control medical factors which can trigger VCD.

A speech pathologist who understands VCD will be crucial in helping you control the VCD symptoms. Speech therapy focuses on breathing techniques to get air in during an attack since medications typically do not help.

The basics include mastery of diaphragmatic (lower abdominal) breathing, reduction of upper body tension, and relaxed-throat breathing strategies. Learning whole-body 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.