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36 Sanford Street
Fairfield, CT

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Trumbull, CT

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Asthma can be a challenging condition to diagnose. If your asthma has been difficult to control, it is possible you have vocal cord dysfunction (VCD). The classic symptoms of asthma are cough, shortness of breath and a whistling sound when breathing out called wheezing. Typical asthma symptoms are produced by obstruction to airflow in lung airways less than one millimeter in diameter. This is caused by mucous build-up in the lungs and contraction of small muscles that wrap around the airways. The feature that differentiates asthma from other obstructive lung diseases such as emphysema and chronic bronchitis is that asthma is completely reversible. In between attacks, examination and breathing tests may be entirely normal. Unless abnormalities are found on physical examination or a breathing test, an asthma diagnosis may be only an educated guess (left). There are many other maladies that can cause intermittent symptoms that resemble asthma. A common one is vocal cord dysfunction. In this disorder, the vocal cord movement is “paradoxical”. This means the vocal cords, instead of moving apart when inhaling, as normal cords do, move together. Consequently, the vocal cords block the airway, producing a whistling sound, shortness of breath and coughing that can be confused with asthma. What is more misleading is that vocal cord dysfunction occurs in about forty per cent of people with asthma as well as independently of true asthma. There are several causes of VCD. It is most commonly triggered by acid reflux into the throat, which causes the cords to come together to block acid entry into the lungs. Psychological factor are also suspected in some people after other causes have been excluded. Neurologic diseases can affect the muscles of the voice box causing difficulty controlling the vocal cords. Inhaled allergens have also been seen to trigger VCD. VCD should be considered when standard treatments for asthma are failing. Diagnosis can be confirmed in my office by a procedure known as rhinolaryngoscopy. This involves passing a very small flexible endoscope (right) into the back of the nose to visualize the vocal cords. Abnormal movement of the cords may be seen, or the presence of inflammation of the voice box can suggest the diagnosis. When no underlying medical condition is found, speech therapy may restore proper breathing and movement to the vocal cords. If your asthma is difficult to control or not responding to standard therapy, come in for evaluation.