Shortness of breath, a wheeze, and a chronic cough are typical signs of asthma
. Changes in temperature, strong odors or perfumes and exercise are typical asthma triggers
. But, not all breathing problems are caused by asthma. These are also signs and triggers of Paradoxical Vocal Fold Motion (PVFM), more commonly known as Vocal Cord Dysfunction (VCD). VCD is not asthma, though VCD can occur with asthma in 50% of patients.
Your vocal cords are deep in your throat at the top of the airway (trachea). We breathe without giving it much thought. Air moving in and out push the vocal cords open to let air flow from the lungs through the airway; a small vacuum effect and muscles let the air flow out and helps them to close. This opening and closing pattern is repeated as you breath.
In VCD the pattern is upset, and the cords stay closed longer, making it harder to breathe in. The vocal cords also do not open all the way, either when breathing in or out. This leaves just a small opening for the air to move through which also makes it hard to breathe. In some cases, breathing in will cause a high-pitched sound called stridor. The symptoms of VCD include shortness of breath, hoarseness, wheezing, long-lasting cough, throat clearing, and tightness in the throat or upper chest. Changes in temperature, strong odors or perfumes and exercise are triggers for VCD. With asthma, it's usually harder to breathe out than to breathe in. The opposite is true for VCD, and VCD episodes are usually short, often only minutes, but those minutes are stressful, uncomfortable and frightening.
The signs and triggers for VCD and asthma look so much alike that it makes it hard to tell what is happening in the airway, and tricky for a doctor to diagnose correctly. Even though it's hard, the patient should try to notice what happens when they breathe in and out, and tell their doctor about it. To make a diagnosis, breathing tests and special tools to look at the vocal cords may be needed. The treatments for asthma and VCD are very different so the right diagnosis is important.
Once diagnosed, treating VCD is usually straightforward. The usual treatment for VCD involves teaching the patient breathing exercises and ways to relax their vocal cords. Learning how to control coughs and new ways to clear the throat can also be helpful. Speech-language pathology (speech therapy) can help diagnose and treat a person with VCD. If there is asthma along with VCD, the asthma action plan should be followed, but should be updated with a doctor to see if medications can be stepped down.
Learn more about breathing exercises that are helpful for VCD
Peter LaPine, PhD, is an associate professor in the Department of Communicative Sciences & Disorders at Michigan State University.