Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders.

Area of Science:

• Pulmonology
• Otolaryngology

Background:

• Vocal cord dysfunction (VCD) and dysfunctional breathing (DB) disorders are often misdiagnosed as asthma.
• This can lead to unnecessary corticosteroid use and associated morbidity.
• VCD, or paradoxical vocal fold motion disorder (PVFMD), involves paradoxical vocal cord adduction during inspiration, causing airflow obstruction and dyspnea.

Purpose of the Study:

• To highlight the diagnostic challenges and management strategies for VCD and DB.
• To emphasize the importance of differentiating these conditions from asthma to prevent iatrogenic complications.

Main Methods:

• Review of clinical characteristics, risk factors, and diagnostic methods for VCD and DB.
• Discussion of current and potential therapeutic interventions.
• Emphasis on the role of flexible fiberoptic rhinolaryngoscopy in VCD diagnosis.

Main Results:

• VCD can affect various populations, including athletes and military recruits, and may be triggered by irritants or reflux.
• Diagnosis can be challenging due to normal findings between episodes; spirometry may show variable extrathoracic airway obstruction during symptoms.
• DB shares overlapping features with VCD and asthma, with poorly understood pathophysiology and diagnostic criteria.

Conclusions:

• Accurate diagnosis of VCD and DB is essential to avoid inappropriate asthma treatment.
• Management requires identifying and treating underlying conditions (e.g., reflux, anxiety) and a multidisciplinary approach, including speech therapy.
• Effective treatment can lead to the discontinuation of corticosteroids and a good prognosis.