Vocal Cord Dysfunction

VCD is most often misdiagnosed as asthma and therefore ineffectively treated with asthma medications. First described by Christopher et al. (1983), VCD was recognized when patients presenting with asthma-like symptoms did not respond to the standard asthma therapies. The syndrome of VCD manifests with asthma-like signs and symptoms but is distinct from asthma in that the pathophysiology involves paradoxical vocal cord closure during inspiration (the obstruction being outside of the chest), in contrast to the hyperreactive airway response found in the asthmatic spectrum of disease. In addition to the classic wheezing heard in patients with asthma (difficult to differentiate by auscultation), patients with VCD have other symptoms, including dyspnea, chest or throat tightness, and cough, all of which simulate asthma symptoms. Most authors recognize VCD as having a strong psychological component, which would place the syndrome on the extreme end of the spectrum of psychosomatic diseases (see Figure 20-1).

Although first described in four adults and one adolescent, VCD is now well recognized in children as well as adults (for a review, see Noyes and Kemp 2007). VCD is more likely to be seen in preadolescents and adolescents than in younger children and occurs far more commonly in female than male patients. In a report of 95 patients admitted to the National Jewish Medical Center over an 8-year period, Newman et al. (1995) characterized typical patients with VCD as overweight, unmarried young women who tended to be employed in health care-related jobs. Roughly half of the patients in their series were diagnosed with both VCD and asthma. Virtually all the reports and studies of VCD patients emphasize the high prevalence of comorbid psychiatric problems, with frequent references to somatoform illness, conversion disorder, factitious asthma, hysterical stridor, and psychogenic wheeze (Noyes and Kemp 2007). Other authors emphasize that adoles cent patients with VCD are high academic achievers, participating in competitive organized sports and other high-profile extracurricular activities (Noyes and Kemp 2007). Depression has been frequently noted as a co-occurring psychiatric condition with VCD (Noyes and Kemp 2007).

Treatment recommendations for VCD are varied. Speech therapy has been helpful for some patients, often in combination with some form of psychological counseling or psychotherapy. Hypnosis and biofeedback have been used with varying success rates. Some authors have reported benefits from sedative anxiolytic medications, and inhaled helium has been used to abort symptoms in acute attacks of laryngeal obstruction. In a report by Do-shi and Weinberger (2006), ipratropium bromide was prescribed and used successfully to prevent symptoms of exercise-induced VCD. Although many types of treatment have been recommended and attempted in pediatric patients with VCD, none has been found to be uniformly and reliably effective. However, the consensus of nearly all experts is that some form of psychotherapeutic modality, along with speech therapy and/or pharmacotherapy, is most likely to be beneficial. The natural course of this syndrome and the prognosis are not known.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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