The Asthma Center

Vocal Cord Dysfunction

Asthma is commonly associated with symptoms of chest tightness, shortness of breath, coughing and/or wheezing. Although these symptoms are mostly associated with asthma, they actually may be signs of an entirely different respiratory problem. The statement "all that wheezes is not asthma" is well known to allergists, and this is particularly true of the condition known as vocal cord dysfunction (VCD) or paradoxical vocal cord adduction. Unlike asthma, VCD is caused by restricted air flow in the upper airway resulting from sudden spasm or constriction of the vocal cords. If you suffer from VCD, you usually have symptoms of troubled breathing and/or wheezing. In addition, you may commonly complain of throat tightness, hoarseness and difficulty getting air in. Since these symptoms are so similar to those of asthma, you may be initially misdiagnosed as having asthma. This is why a specialist should perform a comprehensive evaluation when presenting with recurrent symptoms of difficulty breathing.

VCD results in symptoms when the vocal cords pull together tightly during inspiration (breathing in), thus closing off or narrowing the passageway of the upper airway. This results in symptoms of shortness of breath and noisy breathing due to the restricted air flow, which becomes most prominent during inspiration. Although whistling sounds heard during inspiration may sound similar to wheezing, they are higher pitched and most prominent when breathing in. These sounds are called stridor. In contrast, asthmatic wheezing is most prominent when exhaling. Episodes of VCD often occur more during the day than at night, while poorly controlled asthma symptoms are often worse at night. Vocal cord dysfunction can be triggered by stress, exercise, and irritants (like gas, smoke, fumes, dust, cleansing agents, pungent odors, solvents), but in many cases the cause is unknown.

If you have VCD, but have been misdiagnosed with asthma, you may be treated unsuccessfully with asthma medications. You could be admitted to emergency rooms and even hospitalized while continuing to be misdiagnosed and treated for asthma. Failure to recognize vocal cord dysfunction often leads to using even more potent asthma medications (e.g. corticosteroids) in an effort to control persistent symptoms. However, occasionally both vocal cord dysfunction and asthma can coexist. In this situation, both respiratory disorders will need to be treated simultaneously in order to fully control symptoms.

Treatment usually involves working with a speech pathologist and a behavioral therapist. Occasionally Botox® injections temporarily can relax vocal cords. Surgical intervention is rarely necessary.