Vocal Cord Dysfunction (VCD)

This information was reviewed and approved by J. Tod Olin, MD, MSCS (8/31/2017).

Vocal cord dysfunction (VCD) is also known as inducible laryngeal obstruction (ILO). It is also called paradoxical vocal fold motion (PVFM).

If VCD symptoms happen only during exercise, then it is called exercise-induced laryngeal obstruction (EILO). This problem causes shortness of breath which can be very severe.

VCD/ILO is a serious condition. It can cause extreme changes in quality of life. VCD/ILO is frequently misdiagnosed as asthma.

For all the miles Jack Robb has run over the years, it was only recently that he began to struggle to breathe.

At times, he says, it was so scary, he started to panic.

Everything just starts moving real slow. You feel like somebody has a hand over your mouth and you just can't let loose.

Jack was diagnosed with asthma brought on by his workouts, and his doctor prescribed an inhaler.

But within two weeks, even that wasn't enough.

Jack might not even have exercise-induced asthma, or if he does, it wasn't the complete diagnosis.

And that's much more common than you might think.

Dr. Todd Olin is a lung specialist at National Jewish Health in Denver.

As the leading respiratory hospital in the nation, thousands of asthma patients are referred here for further testing.

But a recent study among those patients found one in four didn't even have asthma, and 70% had other conditions that went undiagnosed.

While it's logical for a general practitioner to treat a breathing problem in a child as asthma, there are other breathing problems out there.

And for the children that are failing therapy, we need to think about those other diagnoses.

Including things that mimic asthma, like allergies, acid reflux, and even heart problems.

During a sophisticated test like this, doctors used a camera to watch Jack's throat during exercise and diagnosed him with vocal cord dysfunction.

It's not asthma and can't be fixed with asthma medicine.

I personally find that speech therapists are the mainstay of therapy.

However, sports psychologists are hugely important.

Dr. Olin says if you have a child with asthma who continues to struggle, even with medicine, you may want to rethink the diagnosis to get them on a more appropriate path to good health.

At National Jewish Health in Denver, this is Clark Powell reporting.

Normal and Abnormal Vocal Cord Function

To understand VCD/ILO, it is helpful to understand how the vocal cords function. The vocal cords are located at the top of the windpipe (trachea). They vibrate to produce noise and voice. Breathing causes the vocal cords to open. This allows air to flow through the windpipe (trachea) and into the lungs. During episodes of VCD/ILO, the vocal cords partly or completely tighten. This causes shortness of breath.

Vocal cord dysfunction is different from vocal cord paralysis.

History of VCD & EILO

VCD/ILO was discovered relatively recently. Some descriptions of possible cases first appeared in medical literature in 1842 and then again in 1951. Both times it was inaccurately characterized as having self-created symptoms.

In 1983, a group of people who were said to have "uncontrolled asthma" were evaluated at National Jewish Health. A team of medical professionals, including pulmonologists, otolaryngologists, psychiatrists and speech-language pathologists provided the evaluation. They accurately identified the condition and provided treatment for what we now know as VCD. Their findings were published in the New England Journal of Medicine in 1983.

People with symptoms limited to exercise were described in the years that followed. Since the 1980s, we have come to realize that they do not share all of the features seen in the first group described in 1983.