Differentiating vocal cord dysfunction from asthma

Abstract

Vocal cord dysfunction (VCD)-associated symptoms are not rare in pediatric patients. Dyspnea, wheezing, stridor, chest pain or tightness and throat discomfort are the most commonly encountered symptoms. They may occur either at rest or more commonly during exercise in patients with VCD, as well as in asthmatic subjects. The phase of respiration (inspiration rather than expiration), the location of the wheezing origin, the rapid resolution of symptoms, and the timing occurring in relation to exercise, when VCD is exercise induced, raise the suspicion of VCD in patients who may have been characterized as merely asthmatics and, most importantly, had not responded to the appropriate treatment. The gold standard method for the diagnosis of VCD is fiberoptic laryngoscopy, which may also identify concomitant laryngeal abnormalities other than VCD. However, as VCD is an intermittent phenomenon, the procedure should be performed while the patient is symptomatic. For this reason, challenges that induce VCD symptoms should be performed, such as exercise tests. Recently, for the evaluation of patients with exercise-induced VCD, continuous laryngoscopy during exercise (such as treadmill, bicycle ergometer, swimming) was used. A definite diagnosis of VCD is of importance, especially for those patients who have been erroneously characterized as asthmatics, without adequate response to treatment. In these cases, another therapeutic approach is necessary, which will depend on whether they suffer solely from VCD or from both conditions.

Impact of comorbid conditions on asthmatic adults and children

“…VCD is often suspected by the increase in the level of symptoms at the time of physical examination and by the presence of audible wheeze from the mouth over the lung fields on auscultation 35 . Diagnosis of VCD can be difficult to confirm as physical examination and spirometry may be normal between episodes 36 .…”

Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy

“…It tends to occur in adolescent athletes. In these cases, a continuous laryngoscopy during an exercise (CLE) test is recommended for the assessment not only of VCD but also of laryngeal obstruction at the supraglottic level [ 25 , 26 ].

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Is it severe asthma or asthma with severe comorbidities?

“… 17 The symptoms of VCD include high-pitched wheezing, usually more prominent with inspiration, hoarseness, dysphonia and cough. 18 Symptoms are often episodic with rapid resolution, with or without therapy. Patients may be misdiagnosed with asthma when VCD is responsible for their symptoms or have VCD and asthma simultaneously.…”