Vocal Cord Dysfunction (VCD) – A Very Misunderstood Illness

Have you noticed an increased shortness of breath or tightness in your chest when exercising? Do you feel like you’re choking or do you experience wheezing when you take part in strenuous activities? Does your voice feel hoarse after working out? Many of these symptoms are common in patients who are diagnosed with vocal cord dysfunction.

Commonly misdiagnosed as asthma, vocal cord dysfunction (VCD) is a function disorder of the vocal folds, which are located in the “voice box.” VCD is characterized by abnormal movement of the cords resulting in respiratory symptoms. Patients with VCD typically experience symptoms during inspiration or when they take a breath in. This is because the vocal cords close at a time when they usually would not. VCD can occasionally cause symptoms during exhalation, but this is less common. VCD poses challenges for both patients and providers as it can mimic and co-exist with asthma. However, an asthma attack is treated very differently than a VCD attack, and misdiagnoses can lead to inappropriate and unnecessary treatments.

The most common symptoms seen in VCD include difficulty with shortness of breath, throat tightness, difficulty swallowing, feeling like something is “stuck” in your throat, choking, gagging, voice changes (hoarseness, raspiness, loss of voice) and wheezing. The “wheezing” that occurs with VCD is a high-pitched wheeze-like sound that comes from the throat, not the lungs, as seen in asthma.

There are several possible causes of VCD, some of which result in irritation of the vocal cords, leading to the abnormal movements. Underlying issues or coexisting conditions are also common with VCD and can sometimes even lead to misdiagnosis. These include heartburn (GERD or reflux), post-nasal drainage from poorly controlled allergies, viral upper respiratory illnesses or colds, depression, anxiety, irritable bowel syndrome (IBS) and chronic pain syndromes. Exercise and inhaled irritants (strong scents/smells like colognes, perfumes, cleaning agents and fumes) are also very commonly identified triggers.

Direct visualization of the abnormal vocal cord movements via rhinolaryngoscopy (camera scope through the nose and down the back of the throat) is the gold standard for diagnosing VCD. However, if the patient is not actively having a VCD attack with the symptoms listed above, then this scope will be normal at the time, Therefore, normal rhinolaryngoscopy cannot definitely rule out a diagnosis of VCD. A pulmonary function test can help to diagnose VCD as well, but this can also be normal in VCD patients. More likely, your board-certified allergist can diagnose VCD based on symptoms and history. 

The mainstay of VCD treatment involves recognizing triggers, appropriately managing co-existent diseases, and utilizing breathing exercises. If patients have difficulty with these exercises, their allergist may refer them to a speech therapist to help as well. Education for patients on the signs and symptoms of VCD and how they differ from asthma can help to reduce unnecessary emergency department visits, hospitalizations, procedures, breathing treatments and steroids.

Statistics on VCD are really hard to find because of how often it is missed. It is almost always diagnosed as something else at first. Our practice has seen many patients who have been treated for “asthma” for years with inhalers and steroids, but all they really needed was vocal cord exercises and maybe some help from speech therapy. 

Treatment by a board-certified allergist for VCD is critical because of how much time, money, energy and unnecessary medications, procedures and emergency department visits/hospitalizations are present on misdiagnosed VCD patients. The treatments for these other issues are not only unnecessary and unhelpful for VCD patients, but they can have side effects of their own. Incorrect treatments for VCD often include inhalers, prednisone or the unnecessary use of EpiPens. Additionally, VCD is seen in a significant amount of the asthma population. VCD attacks and asthma attacks have subtle differences that can be picked up on once patients are better educated. The typical treatments for asthma don’t help with VCD and vice versa.

If you believe you might be experiencing VCD symptoms, scheduling an appointment with a board-certified allergist can lead to a diagnosis and proper treatment so that you can find relief. Request an appointment with our team today.