In normal breathing, the vocal cords open wide during inhalation to allow air into the lungs. In VCD, the cords paradoxically close or partially close during inhalation, narrowing the airway and causing:
- Sudden difficulty breathing, especially on inhalation
- A high-pitched sound when breathing in (inspiratory stridor)
- Throat tightness or a choking sensation
- Voice changes or hoarseness during or after an episode
- A sensation that the throat is "closing"
Episodes can be frightening and short-lived (seconds to minutes) or more prolonged. They often resolve spontaneously.
VCD vs. Asthma: Key Differences
VCD and asthma can coexist, but they require different management. Key distinguishing features include:
| Feature | VCD | Asthma |
|---|---|---|
| Breathing difficulty | Primarily on inhalation | Primarily on exhalation |
| Sound location | Stridor originates in the throat | Wheezing originates in the chest |
| Response to rescue inhaler | Little to no relief | Bronchodilators help |
| Spirometry pattern | Flattening of the inspiratory loop | Obstructive pattern in the expiratory loop |
Many patients with VCD have been prescribed escalating doses of asthma medications without benefit. An accurate diagnosis is essential to avoid unnecessary treatment and to address the real cause.
What Triggers VCD?
Common VCD triggers include:
- Airborne irritants (perfumes, cleaning products, smoke, cold air)
- Exercise (exercise-induced VCD, common in athletes)
- Stress, anxiety, or emotional triggers
- Gastroesophageal reflux disease (GERD) or post-nasal drip
- Upper respiratory infections
Understanding a patient’s specific triggers is a key part of effective management.
How Is VCD Diagnosed?
Diagnosis can be challenging because episodes are episodic and may not be present during a scheduled visit. Diagnostic approaches include:
- Detailed history and symptom review
- Spirometry with inspection of flow-volume loops (flattened inspiratory loop suggests VCD)
- Laryngoscopy (visual examination of the vocal cords, performed by ENT) – definitive when performed during an episode
- Exercise challenge testing, which can sometimes provoke an episode for observation with ENT
- Trial of VCD-specific therapies to assess response
Treatment of Vocal Cord Dysfunction
The primary treatment for VCD is speech therapy with a certified speech-language pathologist (SLP) who specializes in voice and laryngeal disorders. Techniques include controlled breathing exercises and laryngeal control strategies that patients can use to abort episodes. We review basic breathing exercises and provide an educational handout.
Additional treatment components often include:
- Identification and reduction of personal triggers
- Treatment of contributing conditions such as GERD, sinusitis, or post-nasal drip
- Psychological support or counseling if anxiety or stress is a significant trigger
- Coordination with ENT and speech therapy specialists as needed
South Bay Allergy and Asthma Group works collaboratively with your broader care team—including ENT specialists who can perform laryngoscopy and evaluation before referring to an SLP—to ensure a coordinated, comprehensive approach to your breathing health.
Do You Have Asthma, VCD, or Both?
VCD and asthma commonly coexist. If you have a confirmed asthma diagnosis but your symptoms are not well controlled despite appropriate treatment, it is worth evaluating whether VCD may also be contributing. Our physicians have the expertise to assess both conditions and tailor your treatment plan accordingly.
As our physicians note: "It is crucial to diagnose VCD as it can drastically improve a patient’s daily quality of life. VCD has a significant impact on physical, emotional, and psychological wellbeing—symptoms can flare unexpectedly at work, unnecessarily limit exercise tolerance, and increase medication burden, especially inhaled steroids, when patients are misdiagnosed with asthma."
Ready to Schedule?
Call us at (408) 286-1707 or request an appointment online. Offices in San Jose, Los Gatos, Mountain View, and Redwood City.