March 24, 2017

Asthma or Vocal Cord Dysfunction? Could You Tell the Difference in Symptoms?

Carlyn Morris, a 16-year-old cross country runner, likes to push herself to be the best she can be.

“That’s why I love running. I can be competitive with myself,” said Morris, who has been training for cross country and track meets since middle school.

For her first meet of the 2016 cross country season, she had a particular goal in mind.

“I was super excited and really wanted a personal record,” said Morris. At least that was her plan at the starting line that September afternoon. Morris shot out in front, setting a pace for a personal best. Even when her running partner urged her to slow down, Morris pressed onward. But about halfway through the race, as Morris ran by, she motioned to her mom, pointing to her throat. In the final lap, it was clear something was wrong. Morris ran up and collapsed in her mom’s arms. “It’s hard to think when you can’t breathe. I was just scared,” said Morris.

Since Morris had been diagnosed with exercise-induced asthma in middle school, she and her mom suspected asthma was to blame when they visited Steven Julius, MD, a pediatric pulmonologist at Mission Children’s Hospital.

“With symptoms so similar, a condition called vocal cord dysfunction (VCD) is often confused with asthma,” said Dr. Julius. That’s why he listens so intently as his patients describe their symptoms. The details can tell a different story.

Normally our vocal cords open to allow air to move in and out of our lungs, but with VCD, the vocal cords close when we breathe in, blocking most air flow. “Patients often describe the frightening sensation of suffocating,” said Dr. Julius. Episodes of VCD mostly last minutes but can last for hours.

Morris’s symptoms are classic for VCD. Her throat suddenly tightening, especially in stressful situations, is a telltale sign. “It felt like there was a wall at the back of my throat, and no air could get through it,” said Morris. VCD is often brought on by exercise but can also be triggered by irritants like smoke, postnasal drip, reflux or even strong odors. Sometimes a noisy inhale, called stridor, accompanies VCD, compared to a wheeze when asthma patients exhale. Highly motivated young adults are most often affected, and young women are three times as likely to have VCD as young men. “For Carlyn, the combination of running hard and the stress of performing well during the meet created the perfect storm for her episodes,” said Dr. Julius.

“I often reassure my patients that this condition is manageable and almost always reversible,” said Dr. Julius. Morris is learning exercises to engage different muscles in her face to refocus attention away from her vocal cords. Breathing through clenched teeth is just one exercise Morris can do while she’s running. She’s also set to see a speech therapist to help her practice other relaxation techniques to redirect her mind away from her vocal cords in stressful situations. “It’s empowering when patients realize they can regain control of their breathing,” said Dr. Julius.

Symptoms – Asthma vs. VCD

Asthma

  • Shortness of breath
  • Coughing, more so with colds, exercise, at night or with other triggers
  • Wheezing
  • Chest tightness
  • Relief from asthma rescue therapy

VCD

  • Shortness of breath
  • Coughing during episodes
  • Noisy breathing (most often stridor)
  • Neck or upper chest tightness
  • Hoarse voice or difficulty speaking
  • Asthma medications don’t ease symptoms

Steven Julius, MD, is a pediatric pulmonologist at Mission Children’s Hospital.

If you have questions about asthma or any breathing problems, our specialists at Mission Children’s Hospital can help. To set an appointment, call (828) 213-1740.