Vocal Cord Dysfunction: When Breathing Feels Blocked

Vocal Cord Dysfunction (VCD), sometimes called paradoxical vocal fold motion (PVFM), is a condition where the vocal cords involuntarily close when they should open—particularly during inhalation. This can cause symptoms similar to asthma, such as shortness of breath and wheezing, and is often misdiagnosed. Understanding VCD is essential for those experiencing unexplained breathing difficulties, especially during exercise or stress.

What is Vocal Cord Dysfunction?

VCD is a functional breathing disorder where the vocal cords (also called vocal folds) close or constrict at the wrong time. Normally, the vocal cords open to allow air into the lungs. In people with VCD, they partially close instead, leading to airflow obstruction in the throat rather than the lungs.

"Vocal Cord Dysfunction is often mistaken for asthma, but it originates in the upper airway rather than the lungs."
— American Academy of Otolaryngology

Common Triggers and Causes

While the exact cause of VCD remains unclear, several factors are known to contribute:

• Exercise (especially in cold air)

• Stress or anxiety

• Gastroesophageal reflux disease (GERD)

• Postnasal drip or chronic throat irritation

• Environmental irritants (smoke, fumes, strong odors)

• Respiratory infections

Unlike asthma, VCD doesn’t involve airway inflammation or bronchospasm.

Symptoms of Vocal Cord Dysfunction

VCD symptoms often appear suddenly and may resolve quickly, making the condition difficult to detect. Key symptoms include:

• Shortness of breath, especially during inhalation

• Tightness in the throat

• Stridor (a high-pitched wheezing sound from the throat)

• Chronic cough

• Difficulty breathing during exercise

• Hoarseness or voice changes

Because these symptoms overlap with asthma, VCD is commonly misdiagnosed, particularly in athletes and individuals with anxiety.

According to the Cleveland Clinic, up to 40% of patients diagnosed with severe asthma may actually have VCD.

Diagnosing Vocal Cord Dysfunction

VCD requires a careful clinical evaluation. Diagnosis often involves ruling out other causes of breathing problems and confirming abnormal vocal cord movement.

Key Diagnostic Tools:

• Laryngoscopy: A flexible camera inserted through the nose visualizes the vocal cords during breathing or speaking.

• Pulmonary Function Testing (PFT): May show a flattening of the inspiratory flow-volume loop.

• Exercise Challenge Tests: Help detect VCD during or after physical activity.

• Symptom History: Detailed accounts of symptom timing and triggers are crucial.

A multidisciplinary team—including ENT specialists, pulmonologists, and speech-language pathologists—is often needed for accurate diagnosis.

Treatment Options for Vocal Cord Dysfunction

Treating VCD focuses on education, trigger avoidance, and behavioral therapy.

Primary Treatment Approaches:

• Speech Therapy: The gold standard treatment. A speech-language pathologist teaches breathing and relaxation techniques.

• Breathing Retraining: Includes diaphragmatic breathing and relaxed throat breathing during episodes.

• Managing Triggers: Addressing GERD, allergies, or stress that may worsen symptoms.

• Psychological Support: Counseling or cognitive behavioral therapy may be helpful if anxiety is a major component.

Medications like bronchodilators or steroids are typically ineffective unless asthma is also present.

Technology in VCD Management

While wearable tech is more often used for lower airway diseases, emerging tools may help in monitoring or supporting VCD management:

• Wearable respiratory trackers: Can capture breathing patterns to detect anomalies during physical activity.

• Voice monitoring apps: May help detect hoarseness or strain that precedes a VCD episode.

• Telehealth for speech therapy: Enables ongoing training and follow-up with speech pathologists.

These tools empower patients to identify triggers and track their progress in therapy.

Living with Vocal Cord Dysfunction

With proper treatment, people with VCD can lead full, active lives. Some helpful practices include:

• Practicing daily breathing exercises

• Warming up the voice and throat before exercise

• Avoiding known irritants and allergens

• Staying hydrated and managing reflux

• Seeking regular follow-up with your care team

Final Thoughts

Vocal Cord Dysfunction is a challenging but manageable condition. Because its symptoms mimic more well-known conditions like asthma, accurate diagnosis and targeted therapy are essential. If you're experiencing unexplained breathing problems that don’t respond to asthma treatments, it’s worth discussing VCD with a specialist.

Resources

• American Academy of Otolaryngology: www.entnet.org

• Cleveland Clinic on VCD: my.clevelandclinic.org

• National Jewish Health – VCD: www.nationaljewish.org

• American Speech-Language-Hearing Association: www.asha.org

• Asthma and Allergy Foundation of America: www.aafa.org