Misdiagnosis: Asthma or Vocal Cord Dysfunction?

Margie M. Comerford, M.Ed., CCC-SLP, is a speech-language pathologist at the Inova Loudoun Hospital Outpatient Rehabilitation Center.

When I was a teenager I was diagnosed with exercise-induced asthma, but the symptoms never quite fit. Years later, while being trained as a speech-language pathologist, I learned about vocal cord dysfunction – and a light bulb went off. The description of that disorder perfectly described my experience.

In fact, vocal cord dysfunction is often confused with asthma. Both conditions cause episodes or attacks that make it hard to breathe. And both asthma attacks and episodes of vocal cord dysfunction can be triggered by exercise.

So what’s the difference? Asthma is a disease of the immune system, and occurs when inflammation (swelling) causes the airways to narrow and tighten.

Vocal cord dysfunction isn’t caused by an immune response. Instead, it occurs when people use their breathing muscles inefficiently. This can put stress on the vocal cords, causing them to narrow or even close.

The key difference between the two conditions: People with asthma usually have trouble exhaling, while those with vocal cord dysfunction tend to have trouble inhaling. Despite that difference, the conditions are easy to confuse.

Who’s at Risk for Vocal Cord Dysfunction?

The condition often emerges in the teenage years, though it can also occur in adults and, occasionally, in younger children. We aren’t sure why, but it tends to develop mostly in girls and women and sometimes in young men – but rarely in adult men.

I often see cases of vocal cord dysfunction in competitive athletes, who tend to hold tension in their neck and chest muscles and can breathe inefficiently during exercise. People with anxiety are also at greater risk of developing vocal cord dysfunction, since one feature of anxiety is shallow breathing.

We also know that people with a type of acid reflux known as “silent reflux,” in which stomach acid comes up into the throat, can be susceptible to vocal cord dysfunction.

And confusingly, asthma and vocal cord dysfunction frequently go hand-in-hand. Often people with asthma learn to breathe in an inefficient pattern, leading to vocal cord dysfunction.

Diagnosing Vocal Cord Dysfunction

If you suspect you or your child has vocal cord dysfunction, start by answering two questions:

1. Do you have more trouble breathing in than out during breathing attacks?
2. Do you have a prescription asthma medication but feel it’s not very helpful in curbing the attacks?

If you can answer “yes” to both questions, vocal cord dysfunction might be a possibility. I recommend seeing a doctor who specializes in allergies and asthma, an ear, nose & throat specialist (ENT) or a pulmonologist. He or she can run a battery of tests to rule out asthma and/or diagnose vocal cord dysfunction.

Treating Vocal Cord Dysfunction

If you are diagnosed with vocal cord dysfunction, know that it can be treated. My speech therapy colleagues and I treat vocal cord dysfunction by teaching our patients how to use their breathing muscle correctly.

Typically we see patients once a week, but we give them plenty of homework to practice in between sessions. If they’re diligent, they can overcome vocal cord dysfunction in as little as 6 weeks, though it can take up to 12 weeks.

A lot of my work is done in the office. But when my clients have exercise-induced vocal cord dysfunction, I try to work with them to learn to control their breathing while they’re engaged in their sport. I’ve gone out to the field with soccer players and to local pools to help my swimmers.

Knowing firsthand how uncomfortable vocal cord dysfunction can be, I’ll do what it takes to help my patients overcome the disorder and breathe easy.

Learn more about the speech therapy services available at Inova Loudoun Hospital.