Mistaken asthma

There is a common saying among doctors that treat asthma: “Not all that wheezes is asthma and not all asthma wheezes”.   This is to remind us to be on the look out for conditions that look like asthma but may not be.

One of the most common asthma mimickers is a condition known as vocal chord dysfunction.  When we speak or sing, the vocal chords tighten and vibrate as a small about of air passes through the narrow opening.   The vocal cords are relaxed during normal breathing, allowing air to easily pass through the trachea.  In a condition called vocal cord dysfunction, the vocal cords and surrounding structures close together, or constrict, during one or both parts of the breathing cycle, partially blocking the windpipe and creating a sensation of not getting enough air.   The symptoms of vocal chord dysfunction are very similar to asthma: shortness of breath, chest tightness, and wheezing.  In fact, patients with vocal chord dysfunction are frequently treated with strong asthma medications including steroids for years before the proper diagnosis is made.

So what causes the vocal cords to tighten during normal breathing?  In many, vocal cord dysfunction is a type of involuntary stress reaction.  The vocal cords tighten during periods of stress.  This may be the case even though an individual does not feel particularly stressed or anxious. Vocal cord dysfunction had recently been recognized a frequent cause of exercise induced shortness of breath, particularly in children involved in school sports.  A child, who has a strong internal drive to win or feels pressure from a coach or parents to do better, may exhibit vocal chord problems.

The most important step in managing vocal chord dysfunction is suspecting it in the first place, particularly in someone who has been diagnosed and treated for asthma but is not responding to typical medications.    Effective treatment includes education and speech therapy.