17623 Vocal Cord Dysfunction

Overview

Vocal cord dysfunction (VCD) is a condition where the vocal cords (the two bands of tissue in your voice box) close partly when you breathe in, making it hard to get air. It is not asthma, but it can feel similar, with wheezing, coughing, or a tight throat. The vocal cords normally open when you inhale; in VCD, they narrow instead, causing breathing problems. VCD is sometimes called inducible laryngeal obstruction or paradoxical vocal cord motion.

Vocal cord dysfunction is not as common as asthma, but it is not rare. Doctors are diagnosing it more often than in the past. It may affect up to 2–3% of people, and it is seen more in people in their teens to 40s.

VCD can affect anyone, but it is more common in teenagers and younger adults, especially athletes. It also appears in people with anxiety, stress, or who have had a respiratory infection. Women and girls may be affected more often than men and boys.

Symptoms

Common symptoms

• Sudden feeling that you cannot get a full breath
• Wheezing, especially when you breathe in (inspiratory wheezing)
• Coughing or throat clearing
• Hoarse voice
• Feeling of a lump or tightness in the throat
• Choking sensation or feeling of suffocation
• Symptoms that come and go, often in episodes

Symptoms in children

• Noisy breathing, especially when breathing in
• Trouble catching breath during exercise or physical activity
• Frequent cough or throat clearing
• Complaining that something is stuck in the throat
• Voice changes after sports or stressful events

Symptoms in older adults

• Shortness of breath during everyday activities
• Wheezing or noisy breathing that may be mistaken for asthma or COPD
• Trouble speaking or swallowing in some cases
• Fatigue from struggling to breathe

Causes

Main causes

• In many cases, the exact cause is not clear.
• Triggers can include exercise, especially vigorous sports or running.
• Stress, anxiety, or strong emotions can set off an episode.
• Inhaled irritants like smoke, fumes, dust, or strong smells may trigger it.
• A recent cold, flu, or respiratory infection can lead to temporary VCD.
• Certain medical conditions, like acid reflux or allergies, may worsen it.

Risk factors

• Being an athlete, especially in competitive sports
• having anxiety or stress
• Being a teenager or young adult, though it can happen at any age
• Having acid reflux (heartburn)
• Being exposed to workplace chemicals or air pollution
• Having a history of intubation (breathing tube) or neck surgery

When to see a doctor

See a doctor urgently if:

• If you have sudden or severe breathing trouble that does not go away with your usual inhaler or breathing exercises, call your local emergency number immediately.
• If you have wheezing that gets worse very quickly, seek urgent medical care same day.

Book a routine appointment if:

• If you have episodes of wheezing or throat tightness that keep coming back, make an appointment with your GP (family doctor).
• If you have been told you have asthma but your inhalers do not help, it is worth asking about VCD.
• If stress or exercise causes breathing trouble more than once or twice, have it checked.

Diagnosis

To diagnose VCD, your doctor will listen to your breathing, ask about your symptoms and triggers, and may arrange tests. The most reliable way is to see your vocal cords with a small flexible camera (called a laryngoscopy). This is done in a clinic and takes a few minutes. Your doctor may ask you to breathe in a way that triggers symptoms, such as running or breathing in certain irritants, to observe how your vocal cords move.

Tests that may be done

• Laryngoscopy (a thin tube with a camera passed through your nose to view your vocal cords)
• Spirometry (a breathing test that measures how much air you can blow out)
• A challenge test, such as exercising on a treadmill, to trigger symptoms while monitoring your breathing
• Chest X-ray or other imaging if your doctor wants to rule out other problems

What to expect at your appointment

You may first see your GP, who might refer you to an ear, nose, and throat (ENT) specialist or a respiratory (lung) specialist. Tests are usually not painful, and you can go home the same day. Your doctor will then explain what VCD is and help you learn breathing techniques and a plan for managing episodes.

Treatment

Treatment for VCD focuses on teaching you to control your vocal cords and throat muscles so they stay open when you breathe in. This is usually done with speech and language therapy or specialized breathing retraining. Many people also benefit from reducing stress and avoiding triggers. Medication is not the main treatment, but sometimes underlying conditions like acid reflux or allergies are treated to help lessen symptoms.

Self-care at home

• Practice slow, relaxed breathing with the diaphragm (stomach breathing).
• When you feel an episode starting, try to breathe in through your nose, if possible, and out through pursed lips.
• Remind yourself that the feeling of choking will pass and that you are safe.
• Identify and avoid known triggers, such as smoke, strong perfumes, or extreme cold.
• Stay calm during an episode — panic can make your throat tighter.

Medical treatments

There is no specific drug to cure VCD. Treatment centers on breathing retraining with a speech-language therapist or a respiratory physiotherapist. Sometimes doctors may recommend treatments for acid reflux, allergies, or anxiety that can worsen VCD. They may teach you biofeedback or relaxation techniques. Inhalers used for asthma do not usually help VCD, though they may be tried if asthma is also present.

When is surgery considered?

Surgery is rarely needed for VCD. In very severe cases that do not improve with therapy, a doctor might consider botulinum toxin (Botox) injections into the vocal cord muscles, but this is only for a small number of patients and is decided by specialists. Surgery on the vocal cords themselves is not a standard treatment for VCD.

Living with this condition

Living with VCD means learning to recognize the early signs of an episode and using your breathing exercises early. Carry a small card or note that reminds you of your techniques. Let family, friends, and teachers or coaches know about your condition so they can help you stay calm. Most people find that with practice, episodes become less frequent and less severe.

Lifestyle tips

• Stay well-hydrated to keep your throat moist.
• Avoid smoking and secondhand smoke, which irritate the vocal cords.
• Reduce stress with 'quiet time', breathing exercises, or other relaxation methods you enjoy.
• Warm up properly before exercise and cool down afterward.
• If you have allergies or acid reflux, follow the management plan your doctor gives you.

Diet and exercise

There is no special diet that cures VCD, but eating a balanced diet and avoiding meals that trigger acid reflux (like spicy or very fatty foods) can help if reflux is a trigger. Exercise is good for overall health, but you may need to modify how you exercise. Start with low-intensity activities, warm up gradually, and use your breathing techniques. A physiotherapist or exercise specialist can help you build up safely.

Mental health and emotional wellbeing

VCD can feel scary and can cause anxiety, especially if episodes are sudden. Many people worry about not being able to breathe, and this fear can actually trigger more episodes. It is important to talk to your doctor about your worries — they can support you and, if needed, refer you to a counselor or psychologist. Stress management and breathing exercises are a big part of treatment. If you are experiencing thoughts of self-harm or a crisis, please reach out to your local emergency services or crisis line right away.

Prevention

VCD cannot always be prevented, but you can reduce how often episodes happen. Avoiding your known triggers, managing stress, and practicing breathing exercises regularly can help. If you have acid reflux or allergies, treating those can lower your risk of VCD episodes. There is no vaccine and no routine screening for VCD.

Complications

If left untreated

• Frequent trips to the emergency room for breathing trouble
• Being treated for asthma unnecessarily, which may lead to side effects of asthma medications
• Avoiding exercise or physical activity due to fear of symptoms
• Increased anxiety and stress about breathing
• Trouble sleeping because of nighttime symptoms

Long-term outlook

With the right treatment, most people feel much better. Speech therapy and breathing retraining are very effective, and many people learn to control episodes within a few months. VCD does not damage your lungs or vocal cords, and it is not life-threatening. You can expect to return to normal activities, including sports, once you learn your techniques. It may take time and practice, but the outlook is hopeful.

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