Vocal cord dysfunction

Overview

Vocal cord dysfunction, or VCD, is a condition where the vocal cords close when they should open during breathing. This makes it harder to get air in, causing a feeling of tightness or wheezing. Unlike asthma, which affects the lower airways, VCD affects the upper airway at the level of the voice box.

VCD is not as common as asthma, but it is not rare. It is increasingly recognized as a cause of breathing problems, especially in young athletes and people with anxiety.

VCD can affect people of any age, but it is most often seen in adolescents and young adults, particularly those who play sports. It also affects people with stress, anxiety, or acid reflux.

Symptoms

Common symptoms

• Sudden difficulty getting air in (breathing in is harder than breathing out)
• A high-pitched noisy sound when breathing in (called stridor)
• Tightness in the throat or chest
• Voice changes, such as hoarseness or a weak voice
• Coughing or clearing the throat often

Symptoms in children

• Breathing trouble during physical activity or play
• Noisy breathing that may wake them up at night
• Trouble catching their breath when excited or upset

Symptoms in older adults

• Symptoms that may be mistaken for worsening COPD or heart problems
• A sudden feeling of choking or throat tightness
• Voice changes that last for a while

Causes

Main causes

• Irritants such as smoke, strong smells, dust, or chemical fumes
• Acid reflux (heartburn) that affects the voice box
• Stress, anxiety, or strong emotions
• Exercise, especially high-intensity or endurance sports

Risk factors

• Having asthma (makes VCD harder to diagnose)
• Gastroesophageal reflux disease (GERD)
• Anxiety or panic disorder
• Being a competitive athlete, especially in sports like swimming, running, or cheerleading

When to see a doctor

See a doctor urgently if:

• If you have severe breathing difficulty, call your local emergency number immediately.
• If you are using an asthma inhaler and it doesn't help your breathing, get same-day medical attention.

Book a routine appointment if:

• If you have repeated episodes of throat tightness or noisy breathing, see your doctor for an evaluation.
• If you have been told you have asthma but your medicines don't seem to work well, ask about testing for VCD.

Diagnosis

A doctor will listen to your breathing, ask about your symptoms, and may perform tests to see the vocal cords and check lung function. The key test is a laryngoscopy, where a thin camera is passed through the nose to view the voice box as you breathe.

Tests that may be done

• Laryngoscopy (looking at the vocal cords with a tiny camera)
• Spirometry (blowing into a tube to measure lung function). A special pattern called 'flattening of the inspiratory loop' can suggest VCD.
• Exercise challenge (bicycle or treadmill) while recording breathing and symptoms

What to expect at your appointment

The tests are not painful. A laryngoscopy takes a few minutes and may cause a tickle or gag feeling, but it is very quick. The doctor will look to see if the vocal cords close when you breathe in. This is a key sign of VCD.

Treatment

Treatment for VCD focuses on teaching you how to breathe calmly and keep the vocal cords open. Speech-language therapists are experts in this. If there are underlying causes such as reflux or anxiety, those are treated too.

Self-care at home

• Practice slow, gentle belly breathing during an episode – breathe in through your nose and out through pursed lips.
• Use breathing techniques taught by a therapist, such as 'relaxed throat breathing' or 'quick sniffs' to open the vocal cords.
• Avoid triggers like smoke, strong smells, and very hot or cold air.
• If exercise is a trigger, warm up slowly and use diaphragmatic breathing while exercising.

Medical treatments

Doctors may treat underlying conditions that can trigger VCD, such as acid reflux (with medicines that reduce stomach acid) and anxiety (with therapy or medications). Because VCD is not a true inflammation of the airway, asthma meds like inhalers usually do not help and are not recommended. Speech therapy is the main treatment.

When is surgery considered?

Surgery is rarely needed for VCD. In very rare cases where the vocal cords have a physical problem, a procedure may be considered, but this is not common.

Living with this condition

Living with VCD means learning to manage episodes with breathing techniques and avoiding triggers. Many people find that being aware of their breathing helps them feel more in control. Keep a note of what seems to trigger your episodes so you can avoid or prepare for them.

Lifestyle tips

• Stay calm during an episode – anxiety can make it worse.
• Drink plenty of water to keep your throat moist.
• Avoid shouting or talking loudly for long periods.
• If your job involves talking a lot, take vocal rest breaks.

Diet and exercise

If you have reflux, avoid foods that trigger heartburn, such as spicy foods, caffeine, and fatty meals. Eat smaller meals and don't lie down soon after eating. For exercise, warm up gradually with breathing exercises to help prevent VCD episodes. Stay well hydrated.

Mental health and emotional wellbeing

VCD can be stressful and scary, and it is common to feel anxious about when the next episode might happen. This anxiety can even make the condition worse. Speak to your doctor if you feel worried – therapy or relaxation techniques can help.

Prevention

While you cannot always prevent VCD, you can reduce flare-ups by managing triggers. Learning breathing exercises before symptoms start can help stop an episode from getting worse. Staying calm and using your techniques early can also prevent symptoms from escalating.

Vaccines

There are no vaccines specifically for VCD. Staying up to date with vaccines for influenza and pneumonia may help prevent respiratory infections that could aggravate your symptoms.

Screening programmes

There is no routine screening for VCD. It is typically diagnosed when someone has breathing problems that do not fit the pattern of asthma or other lung conditions.

Complications

If left untreated

• Being misdiagnosed with asthma and treated with unnecessary medications that may have side effects.
• Frequent emergency room visits because VCD episodes are not recognized.
• Anxiety and avoidance of physical activity or social situations due to fear of an episode.

Long-term outlook

The outlook for VCD is very good. With the right diagnosis and treatment, most people learn to control their episodes and live full, active lives. It is not a condition that damages the lungs or shortens life. With practice, you can manage it well.

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