Vocal chord dysfunction masquerading asasthma?

Report from December 2007:
Vocal cord dysfunction is the sudden, abnormal narrowing of the vocal cords during inhalation causing airflow obstruction and wheezing that can easily be mistaken for an asthma attack.

Dr Karen McCoy, from Columbus Children's Hospital in Ohio, explained: ‘Both asthma and vocal cord dysfunction are very common, and emergency departments across the country are seeing more and more kids with these kinds of symptoms.

‘While they may appear similar to parents, the conditions act differently and must be treated differently. It is important that parents, coaches and family doctors are aware of the differences.’

The researchers, led by Dr Paul Nolan from Texas Tech University HSC in Amarillo, studied 17 young people, aged between 12 and 21 years, who were admitted to the emergency department of Columbus Children's Hospital suffering from a suspected asthma attack. All the patients underwent a breathing test called spirometry, which revealed that 12 of them had vocal cord dysfunction rather than asthma, which resulted in a change of treatment for these patients.

Co-researcher Dr Marjorie Chrysler, also from Columbus Children's Hospital, added: ‘Our study suggests that if more emergency departments made use of the spirometry test, it could cut down on the number of kids who are misdiagnosed and potentially hospitalised.’

January 2010 - An interesting case history:

Vocal cord dysfunction masquerading as "asthma" for 20 years
Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology

A 39-year-old Caucasian female with a diagnosis of allergic rhinitis and asthma for 20 years is referred for evaluation to the allergy clinic. She was on Advair for two years, approximately four years ago, and then Advair was stopped by by her pulmonologist because her pulmonary function tests were normal.

She is here for evaluation of allergic rhinitis by skin prick testing. She has increased shortness of breath with exercise. She reports loss of voice, cough, and shortness of breath when eating or laughing. The symptoms occur throughout the year. She also reports nasal congestion and for that, she takes Allegra D QAM and Allegra QPM .

She rates the nasal symptoms as 5 out of 10 on a zero to 10 scale, when she is off the medication, and down to 1 to 2 out of 10 when she takes Allegra D. She also reports dry cough for 20 years which does not respond to albuterol. She exercises daily and uses albuterol 30 to 60 minutes before exercise, and then during her exercise routine for cough, change in her voice and shortness of breath.

Thealbuterol helps, but it does not relieve her symptoms completely. She was on intranasal steroids in the past, but the spray was used inconsistently and she does not recall the effect of this treatment.

Click here for a full investigation of this case

Vocal cord dysfunction (VCD) is an an abnormal adduction of the vocal cords during the respiratory cycle (especially during the inspiratory phase) that produces airflow obstruction at the level of the larynx.

VCD frequently mimics persistent asthma and is often treated with high-dose inhaled and/or systemic corticosteroids, bronchodilators, and may lead to multiple emergency department visits and hospitalizations.



Click here for more research on the possible causes of asthma

First Published in December 2007 updated January 2010


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