Clinical features of vocal cord dysfunction.

Abstract

Vocal cord dysfunction (VCD) is a respiratory condition characterized by adduction of the vocal cords with resultant airflow limitation at the level of the larynx. Previously, this condition was described in case reports and in small series. This study reviews all patients hospitalized from 1984 through 1991 in whom VCD was diagnosed. Demographic, historical, physiologic, laboratory, and psychiatric factors were statistically analyzed. Ninety-five patients met the criteria for proved VCD; of these, 53 also had asthma. All patients had laryngoscopic evidence of paradoxical vocal cord motion, with inspiratory and/or early expiratory vocal cord adduction. The patients with VCD without asthma were predominantly young women. In these patients, asthma had been misdiagnosed for an average of 4.8 years. Their medications were identical to those of a control group of patients with severe asthma. Thirty-four of the 42 patients with VCD without asthma were receiving prednisone regularly at an average daily dose of 29.2 mg. Medical utilization was enormous with the VCD group, averaging 9.7 emergency room visits and 5.9 admissions in the year prior to presentation. Also, 28% of the patients with VCD had been intubated. We conclude that VCD can masquerade as asthma and that it often coexists with asthma. This study helps to define the historical and clinical features of VCD.

Asthma-related comorbidities

“…Vocal cord dysfunction -a paradoxical adduction of the vocal cords during inspiration -may mimic asthma [155][156][157]. It may or may not be related to psychological disturbances [158].…”

“…It may or may not be related to psychological disturbances [158]. Newman et al reported that 56% of 95 patients with paradoxical vocal cord motion disorder had concomitant asthma [156]. Hussein et al reported vocal cord dysfunction more commonly in women and older individuals, and in association with asthma, GERD and previous abuse [158].…”

Difficult asthma

“…This abnormality may be identified in people with or without asthma. In a series of such patients, 32% had coexistent asthma, which complicate the diagnosis (17). Some of these patients may be treated with large doses of antiasthma therapy, including oral GCS (18).…”

Dyspneic athlete

“…PVFMD is likely underdiagnosed and this has been shown to lead to increased health care costs [50][51][52]. The prevalence is unknown as there are no large, prospective, population based studies [53].…”

“…The proposed mechanism is that these higher ventilation bursts require breathing more through the mouth, resulting in cooler and drier air than can irritate the vocal cords [8•]. PVFMD has been found to be present at rates of up to 40 % among patients with refractory or exercise-induced dyspnea [50,[57][58][59]…”