[Vocal cord dysfunction, an important differential diagnosis of severe and implausible bronchial asthma]

For asthmatics who show-despite of all available therapeutic efforts-an unsatisfactory clinical course in- or exspiratory vocal cord dysfunctions are an important diagnostic consideration. Aside from some case reports, there is only one major study, presenting a prevalence of > 30% in subjects admitted because of refractory asthma.

The question was whether this phenomenon could also be found in our patients, mostly in- or extrinsic asthmatics. In cases suspicious for VCD or with an unexplainable asthma course, we performed videotaped laryngoscopy, including exposure to questionable provocing irritants.

In 14 months, we detected VCD in 16 patients by laryngoscopy and spirometry at the time of severe dyspnea. Subjects were predominantly women. Our therapeutical approach included: explanation of their videotape, speech therapy, breathing techniques and psychological support. In patients, pretreated with systemic corticosteroids, the dose could be reduced remarkably. A benefit 3 month after diagnosis could be shown using a life-quality-questionnaire.

Screening for VCD in patients with unplausible, refractory asthma and other unexplained dyspnea- or wheezing attacks is an important diagnostic consideration in order to prevent unnecessary medical treatment or drug related side-effects and to introduce a specific therapeutical concept.