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| |  DG DISPATCH - CHEST: Patients With Vocal Cord Dysfunction May Present with Asthma Symptoms By Margaret Pearson Special to DG News CHICAGO, IL -- November 2, 1999 -- The symptoms of patients with vocal cord dysfunction (VCD) who seek urgent care are very similar to asthma with wheezing and episodic shortness of breath. Many of these patients are mistakenly diagnosed and treated for uncontrollable asthma.
Vocal cord dysfunction occurs when the anterior two-thirds of the vocal cords are closed off and is most often a stress-related disorder. Treatment for VCD is completely different from that of asthma, consisting of speech therapy and, sometimes, psychological counseling. Researchers conducted a clinical study to determine the incidence of VCD in patients seeking emergency room care. Asthma and VCD can both a relatively sudden onset in young, adult patients which includes episodes of shortness of breath with wheezing and apparent relief with bronchodilators. Thus, VCD may be misdiagnosed and treated as asthma exacerbation with high dose steroids and even intubation. Investigators Drs. Subin Jain and V. Bandi, from Baylor College of Medicine, Departments of Emergency Medicine and Pulmonary Medicine, in Houston, TX, studied 50 patients (average age: 37) who presented to the emergency room for shortness of breath and wheezing and who also were diagnosed with acute asthma. After being given one albuterol nebulizer treatment, patients had laryngoscopy to visualize the vocal cords and pulmonary functions tests to record air flow. The vocal cords were videotaped while collecting air flow and volume data. All subjects received subsequent care by emergency room physicians before being discharged. The results show that five patients had classic vocal cord dysfunction (10 percent), six patients had asthma with vocal cord dysfunction, 34 had asthma alone (68 percent) and four patients had normal lung function and vocal cord tests. Since this study had an equal distribution of sexes and racial mix, the investigators suspect that VCD may be more common than previously believed. VCD may be present in as many as 12 percent of patients seeking emergency room treatment for acute asthma, they said. VCD can only be detected by laryngoscopy. Accurate diagnosis of VCD by laryngoscopy may prevent incorrect and potentially harmful treatment of these patients.
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