Many diseases can either mimic or worsen asthma. One disease which is very common among the patients who are initially considered to have asthma is vocal cord dysfunction. Vocal cord dysfunction can exist by itself or can exist with asthma. Vocal cord dysfunction occurs when the vocal cords do not open and shut properly during breathing or speech. This can cause a great number of symptoms very similar to asthma including wheezing, cough, and shortness of breath. Unlike asthma, patients with vocal cord dysfunction typically do not get better with either a bronchodilator or with corticosteroids. Many patients with vocal cord dysfunction are felt for a long time to have difficult to control asthma and we have seen many patients who have been intubated and placed on a mechanical ventilator in the ICU for presumed asthma when their diagnosis is actually vocal cord dysfunction.
Although vocal cord dysfunction can occur in both children and adults, women tend to be more likely to develop vocal cord dysfunction in adults. For unclear reasons, vocal cord dysfunction occurs more frequently in health care workers but can be seen in people having any occupation. There additionally appears to be a link between vocal cord dysfunction and participation in competitive sports. Although the incidence of vocal cord dysfunction is not entirely clear, many studies suggest that it is the cause of approximately 10% of cases of presumed asthma.
Some of the tests that your doctor may do to diagnose vocal cord dysfunction include pulmonary function studies in which case the flow volume loop can sometimes show suggestive changes during the inspiratory limb of the loop. Unlike patients with asthma, patients with vocal cord dysfunction usually have a normal expiratory limb. This is the opposite of what happens in asthma where the inspiratory limb is relatively normal but the expiratory limb is abnormal.
Vocal cord dysfunction is diagnosed by a test called videolaryngostroboscopy which is generally performed by either an otolaryngologist or a speech pathologist who is experienced in this disorder.
Although the cause of vocal cord dysfunction is unknown, it seems to be brought on by medical conditions such as post nasal drip and gastroesophageal reflux or environmental conditions (such as using the vocal cords strenuously, shouting, or singing; being exposed to tobacco smoke; strenuous physical activity; or exposure to strong chemical fumes). In the experience of the OSU Voice Institute, gastroesophageal reflux appears to be a particularly strongly associated condition. Often, it is not possible to determine whether the gastroesophageal reflux caused the vocal cord dysfunction or vice versa, but frequently, treatment of the vocal cord dysfunction requires both treating the gastroesophageal reflux and treating the vocal cord dysfunction.
Treatment consists of eliminating any precipitating causes (such as gastroesophageal reflux: see Web file on Gastroesophageal Reflux), voice therapy, and sometimes psychological stress reduction.
Voice therapy is generally prescribed by the speech pathologist at the time of videolaryngostroboscopy and usually requires multiple sessions with breathing and voice exercises. Treatment with medications for gastroesophageal reflux can take several weeks before they become effective. In patients under a great deal of psychological stress, stress reduction (often by a psychologist) can be of substantial help. Given the very high frequency of vocal cord dysfunction in the American population, this is a particularly important disease to recognize. Not only can patients eliminate otherwise unnecessary drugs for treating asthma, but patients can also be effectively cured of their symptoms with speech therapy. The importance of this diagnosis cannot be overemphasized. In our own experience at The Ohio State University Division of Pulmonary and Critical Care Medicine, vocal cord dysfunction accounts for approximately 20% of patients referred for disability evaluation because of presumed asthma. For more information or a referral for videolaryngostroboscopy, please call the OSU Voice Disorders Institute at 614-293-8064.
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