Shortness of breath, coughing, wheezing, throat tightness, hoarseness – could it be sinuses, allergies acting up, or the telltale signs that an asthma attack is on its way?
Maybe none of the above.
Notice these symptoms did not involve the chest, as in asthma, which involves airway inflammation. These symptoms are centered in the upper airway, a clue that it may involve something seemingly unrelated to the lungs. Vocal cords vibrate air to make speech and sound. However, in certain people, vocal cords sometimes close shut at inopportune times, which making breathing and speech difficult. It is known as vocal cord dysfunction, or VCD.
The disorder has been known by many different names over the years since it was first identified in 1983 by doctors at National Jewish Health in Denver. The names include facetious asthma, Munchausen’s stridor, pseudo or imitation asthma, functional upper airway obstruction and emotional laryngeal wheezing. Ignorance to the disorder led some health professionals to describe “lying” as a symptom; not believing there was real a physical problem – rather, a psychosomatic illness the person was making up. While its origins are unknown, National Jewish Health in Denver, Colorado identified the physical condition and the disorder is now described as paradoxical vocal cord motion (PVFM) disorder, vocal cord dysfunction (VCD) or vocal fold dysfunction.
Triggers for VCD are similar to asthma triggers, including upper respiratory infections, postnasal drip, reflux issues, exposure to airborne irritants, strong odors, perfumes, fumes, smoke, exercise, singing, laughing, temperature changes, heightened emotions and stress, anxiety or tension. However, not all people who experience VCD have asthma, and people with both conditions may be underdiagnosed, receiving treatment only for asthma.
That’s why the inhalers, “puffers” or topographical corticosteroids don’t work for patients this condition, said Dennis Fuller, PhD, CCC/SLP, a speech pathologist and associate professor at Saint Louis University.
“They are meant to dilate your pulmonary system, basically your bronchi in the laryngeal lining,” Fuller explained. “What this disorder is – literally is closure of the vocal folds. One the classic identification things that I hear and I kind of listen for is: ‘Well, the doctor put me on a puffer and it didn’t work,’ or you’ll say, did the puffer work for you? And the people go, ‘Maybe, but, I haven’t been taking it.’ Which means it doesn’t work.”
Doctors can confirm VCD with two tests. In a laryngoscopy, doctors use a flexible scope down the throat to observe the movement of vocal cords when the patient is having symptoms. The second is spirometry, a test that measures the airflow of patients as they inhale and exhale. The example spirometry results measured airflow three times, factoring in predicted values based on age, gender, height and weight. Fuller said it is a perfect example of vocal cord dysfunction.
“What I look at is the pattern of flow. The top is the exhale the bottom is the inhale,”
“These should look all the same,” Fuller said. “The bottom one should look like a bell curve upside down or like an upside down ice cream cone. It looks like someone took a bite out of the ice cream.”
Fuller said the percentage values from the spirometry also differentiate VCD from asthma. A person in asthmatic distress would have lower percentages of efficiency of airflow, where in the example, they are in the 95-100 percentile.
The good news is rather than medications or invasive measures in extreme cases, many incidences of vocal cord dysfunction can be resolved or managed through speech therapy. Using breathing techniques that have a basis in yoga, therapists teach VCD patients to use breathing exercises to trick the brain to give up its defense mechanism, thus allowing the vocal cords to remain open.
“There is a thousand ways we use our vocal folds,” Fuller said. “In reality, if there was such a thing as an archeologist for the anatomy, all mammals have this valve … it is not there for voice. It is a pulmonary valve.”
Fuller said coughing is a pulmonary function, and without thinking about it, people close their vocal cords when picking up heavy objects, or close their vocal cords during the “flee, fight” response.
“It’s a motor pattern that you set up,” Fuller said. “What happens if you get in a smoky environment? You begin coughing; and why are you coughing? It’s your brain trying to prevent that bad air from going in.”
For more information, visit National Jewish Health at http://www.nationaljewish.org/healthinfo/conditions/vcd.
