Vocal Cord Dysfunction: When Breathing Difficulty Might Not Be Asthma

As a former athlete and current athletic trainer, I have seen a number of athletes present with difficulty breathing, above and beyond simply being out of shape. They often get diagnosed with asthma or exercise-induced asthma, start using an inhaler and begin to feel better. But, sometimes treatment using an albuterol inhaler provides them no relief. 

Further testing sometimes finds that breathing difficulties came from Vocal Cord Dysfunction (VCD), not Asthma. VCD is often confused for asthma, as they share many tell-tale signs: difficulty breathing, coughing, and wheezing. Upon closer inspection, there are several discerning differences between the two breathing disorders. 

What Is VCD and How Does It Differ from Asthma?

Vocal Cord Dysfunction is a disorder where the vocal cords do not open correctly when breathing. The muscles affecting the vocal cords tighten, making it harder to get air into the lungs. With asthma, the bronchi down through the bronchial tubes near the lungs tighten, leading to difficulty breathing. The result is often the same (difficulty breathing), but unlike asthma, VCD is not caused by an allergic response.

There are many possible causes of VCD including exercise, upper respiratory infections, stress/emotional distress, Gastroesophageal Reflux Disease (GERD), or breathing in lung irritants such as tobacco smoke. In addition, VCD leads to difficulty breathing in, versus asthma, which leads to difficulty breathing out.

People suffering from VCD can sometimes present with stridor, or high pitched wheezing heard while breathing in. Asthmatics typically respond well to inhalers, whereas symptoms will not improve for isolated VCD. In some cases, patients present with both asthma and VCD.

How Is VCD Diagnosed and What Is the Treatment?

Your doctor will perform a breathing test (pulmonary function test) or will sometimes use a laryngoscope to observe vocal cords during breathing. This is occasionally performed after bouts of controlled exercise.

• With asthma, doctors will often measure airflow moving out of the lungs
• With VCD, doctors will focus more on airflow going into the lungs

Unique from other respiratory issues, VCD is not treated with medication.

• Speech therapy techniques can improve the ability to relax throat muscles to allow for normal breathing
• Deep breathing exercises are encouraged
• If you suffer from asthma or GERD, managing these issues will help to manage VCD

Athletes with vocal cord dysfunction are still able to train and compete at high levels and find success with appropriate diagnosis and treatment! If your child is in immediate respiratory distress and having trouble breathing, seek emergency care at the nearest hospital emergency room. If you are uncertain about this condition, please contact your primary care provider to determine the best treatment plan.