Vocal cord dysfunction (VCD) is when your vocal cords intermittently malfunction and close when you inhale. This reduces the space available for air to move in and out when you breathe.
It has been found in people of all ages, but most often it’s seen in people ages
Another name for this condition is paradoxical vocal cord motion. Because it sounds and feels a lot like asthma, it may also be called “vocal cord asthma.”
You can have both VCD and asthma.
If an acute episode is mild, you may not have any symptoms.
When you do have symptoms, most of them are caused by inhaled air moving through a smaller area than usual. They come on suddenly and can mimic an asthma attack.
Symptoms for vocal cord dysfunction include:
- shortness of breath
- feeling you’re suffocating, also called air hunger
- wheezing, especially during inhalation
- stridor, which is a high-pitched sound during inhalation
- chronic coughing
- chronic throat clearing
- throat tightness or choking feeling
- hoarseness or weak voice
- chest tightness or chest pain
These symptoms can be frightening, especially when they come on suddenly. Some people feel anxious, panicky, and afraid when they get them. This can make it even harder for you to breathe.
In someone with asthma, similar symptoms can mean they’re having a severe attack that can be life-threatening and needs immediate treatment. One important difference between them is that wheezing is heard when you exhale with asthma, but it’s heard when you inhale with VCD.
Your doctor will ask you questions about your symptoms and possible causes of your episodes of difficult breathing. Some questions can help your doctor determine if you have VCD or asthma. They may ask you:
- to describe your exact symptoms: VCD causes wheezes while breathing in, asthma causes wheezes while breathing out
- what time of day the episodes happen: VCD doesn’t happen when you’re asleep, asthma attacks can
- if anything makes your symptoms better or worse: inhalers can trigger a VCD attack or make it worse, they usually make asthma symptoms better
- if a doctor has confirmed the diagnosis of VCD by looking at your vocal cords
It can be hard to differentiate VCD and asthma. A study showed
Your doctor might notice if you grab your throat or point to it when describing your symptoms. People with VCD tend to do this unconsciously.
There are some tests your doctor might use to diagnose VCD. To be useful, the tests must be performed while you’re having an episode. Otherwise, the test is usually normal.
A spirometer is a device that measures how much air you breathe in and exhale out. It also measures how fast the air moves. During an episode of VCD, it will show a lower amount of air coming in than usual because it’s blocked by your vocal cords.
A laryngoscope is a flexible tube with a camera attached. It’s inserted through your nose into your larynx so your doctor can see your vocal cords. When you take a breath, they should be open. If you have VCD, they’ll be closed.
Pulmonary function tests
For diagnosing VCD, the most important parts are your oxygen level and the pattern and amount of airflow when you inhale. If you have VCD, your oxygen level should stay normal during an attack. In lung diseases like asthma, it’s often lower than normal.
Doctors know that with VCD your vocal cords respond abnormally to various triggers. But they aren’t sure why some people respond this way.
There are known triggers that can provoke a VCD attack. They can be physical stimuli or mental health conditions.
- laryngopharyngeal reflux disease (LPRD), where stomach acid flows backward up to your larynx
- gastroesophageal reflux disease (GERD), where stomach acid flows backward into your stomach
- postnasal drip
- exercise or exertion
- breathing in irritants such as toxic fumes, tobacco smoke, and strong odors
- strong emotions
- stress or anxiety, especially in social situations
- severe depression
Short-term treatment for acute episodes
It may look and feel like it, but severe acute episodes won’t lead to respiratory failure like in asthma.
However, they are uncomfortable and can make you fearful and anxious, which can keep the episode going. There are treatments that can help stop a severe episode by making it easier to breathe or calming your anxiety.
- Continuous positive airway pressure (CPAP). A CPAP’s compressor blows intermittent bursts of air through a mask worn over your face. The pressure from the air helps keep your vocal cords open making it easier to breathe.
- Heliox. This mixture of 80 percent helium and 20 percent oxygen can reduce your anxiety during an acute episode. It’s less dense than oxygen alone, so it passes through your vocal cords and windpipe more smoothly. The less turbulent the airflow is, the easier it is to breathe and the less noise your breathing makes. When your breathing becomes easier and quiet, you become less anxious.
- Anti-anxiety medication. Along with reassurance, benzodiazepines like alprazolam (Xanax) and diazepam (Valium) can make you less anxious, which can help end an episode. These medications can be addictive, so they shouldn’t be used for more than a few days or as a long-term treatment for VCD.
Preventable triggers should be eliminated when possible. Some treatments include:
- proton pump inhibitors, such as omeprazole (Prilosec) and esomeprazole (Nexium) block stomach acid production, which helps stop GERD and LPRD
- over-the-counter antihistamines help stop postnasal drip
- avoiding known irritants at home and work, including smoking and secondhand smoke
- seeking treatment for underlying conditions such as depression, stress, and anxiety
- keep any existing asthma diagnosis well controlled
Speech therapy is the mainstay of long-term management. A therapist will teach you about your condition and can help you reduce the number of VCD episodes and manage your symptoms by giving you a number of techniques. These include:
- relaxed breathing techniques
- ways to relax your throat muscles
- voice training
- techniques to suppress behaviors that irritate your throat such as coughing and throat clearing
One breathing technique is called “quick release.” You breathe through pursed lips and use your stomach muscles to help move air. This causes your vocal cords to rapidly relax.
The keys to managing VCD are to learn to relax the muscles in your voice box and to manage stress.
You should practice the breathing techniques taught by your speech therapist several times a day, even when you don’t have symptoms. This will allow them to be effective in the event of an acute episode.
Conditions such as anxiety, depression, and stress are known to play a big role in triggering acute episodes of VCD. Learning to control these and relieve stress can significantly reduce the number of episodes you have. Ways to do this include:
Many people with VCD are initially diagnosed with asthma. It’s very important that the two conditions be properly diagnosed because they are treated very differently.
Giving asthma medications such as inhalers to someone with VCD won’t help them and can sometimes trigger an episode.
Using speech therapy techniques to treat someone with asthma won’t open the airways inside their lungs and would be disastrous in a severe life-threatening asthma attack.
If you have both VCD and asthma, it can be hard to tell what’s causing your symptoms.
One clue is that medications like rescue inhalers used to treat an asthma attack won’t help if VCD is causing your symptoms. However, sometimes rescue inhalers don’t work for a severe asthma attack either.
If there is any question that you might be having an asthma attack, seek medical help immediately.
Less often, VCD is confused with other types of airway obstruction including:
VCD is often misdiagnosed as asthma. If you have symptoms you think could be VCD or asthma, see your doctor for evaluation. The correct diagnosis is crucial to know what your treatment should be.
An acute episode of VCD can be scary because it feels and sounds like you can’t breathe. The best thing to do is be prepared by learning ways to relax your vocal cords, body, and mind. Using these techniques can reduce the number of episodes you have and help stop them.