Written by Liana Hase-Penn | Edited by Kaelyn Kwon
Photo by Gustavo Fring
Many medical conditions oftentimes may appear to be others on the surface, leading to misdiagnosis. A key example of this is Vocal Cord Dysfunction, defined as the inwards movement of the vocal cords (bands of muscle in the voice box that produce sound) which causes an uncomfortable tight feeling, wheezing, shortness of breath, and high-pitched sounds when breathing in [1]. Since it was first discovered, VCD has been relatively forgotten and oftentimes misdiagnosed due to its similarities to asthma. In fact, a study by the University of Colorado Health Sciences Center found that 95 patients with VCD were misdiagnosed for an average of 4.8 years before receiving a correct diagnosis. Asthma is an inflammation of the lung’s airways, which narrows the tubes air passes through and causes breathing difficulty [2]. While VCD and asthma have similar symptoms, they possess separate causes, affect different parts of the body, and require distinct treatments.
VCD can be developed by the vocal cords closing due to hypersensitivity to inhaled irritants (like smoke or air pollution), acid reflux (acid rising into the throat from the stomach), or emotional trauma [3]. Asthma can be caused by substances that cause allergies (allergens), air pollutants, exercise, or childhood infections [4].
Despite slight differences in how these disorders develop, asthma and VCD impact different parts of the body. Asthma affects the patient’s air passages when breathing out, while VCD influences the upper airway when the patient breathes in [1]. Yet, shortness of breath, also known as dyspnea, is a common symptom in both disorders. In addition to shortness of breath, other symptoms present in individuals with VCD are similar to those caused by asthma, which is why VCD is often misdiagnosed as such.
While the symptoms of VCD and asthma are similar, the treatments for the two conditions are very distinctive. Short-term solutions for asthma include fast-acting medications that quickly open the airways or can reduce swelling. Most commonly, patients are prescribed these medications in the form of a device called an inhaler, which relieves symptoms right away by delivering a precise amount of medicine via inhalation [5]. While asthma is treated with medications and inhalers, these do not benefit patients with VCD, leading to costly and ineffectual drug use if a patient with VCD is misdiagnosed with asthma. Instead, treatment plans for patients with VCD are non-pharmaceutical and can include speech therapy and engagement in assigned breathing exercises [6].
Since the first recorded appearance of VCD in 1842, research has progressively led to an improved understanding of the disorder. At first thought to be a psychological condition, VCD was identified as a physical condition in the 1980s [7]. However, recent studies have found high social stresses coupled with anxiety and stress to be associated with VCD [3]. In contrast, asthma has always been considered a physical condition, although there is some speculation that there are links to psychological conditions.
Therefore, it is important to have a better understanding of the differences between these two conditions given crucial distinctions in treatment and development. However, VCD still remains an underrepresented condition. From its initial characterization as a psychological condition and lack of research, VCD requires further research for advocacy. It is important to increase awareness of VCD to the same level of understanding as asthma to better recognize Vocal Cord Dysfunction as a potential diagnosis.
References:
[1] Fretzayas A, Moustaki M, Loukou I, Douros K. (2017) Differentiating Vocal Cord Dysfunction from Asthma. J Asthma Allergy. 10:277-283
[2] Dunn N.M, Katial R.K, Hoyte F.C.L. (2015) Vocal Cord Dysfunction: A Review. Asthma Res Pract. 1:9
[3] “Vocal Cord Dysfunction (VCD)” Mount Sinai. Icahn School of Medicine at Mount Sinai. 2024 https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/vocal-cord-dysfunction#:~:text=It%20is%20a%20maladaptive%20learned,triggers%2C%20or%20even%20emotional%20trauma. Accessed 28 Feb. 2024
[4] “Asthma Causes & Risk Factors” American Lung Association. 19 April 2023 https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-causes-asthma Accessed 28 Feb. 2024
[5] Sharma S, Hashmi M.F, Chakraborty R.K. (2023) Asthma Medications. StatPearls [Internet].
[6] Li, James T.C. “Vocal Cord Dysfunction: Is It a Type of Asthma?” Mayo Clinic, 5 Mar. 2022, www.mayoclinic.org/diseases-conditions/asthma/expert-answers/vocal-cord-dysfunction/faq-20058019#:~:text=Like%20asthma%2C%20vocal%20cord%20dysfunction. Accessed 9 Feb. 2024
[7] Ibrahim W.H, Gheriani H.A, Almohamed A.A, Raza T, (2007) Paradoxical Vocal Cord Motion Disorder: Past, Present and Future. Postgraduate Medical Journal. 83:164–172