Feature Article

Vocal cord dysfunction: the great mimicker of asthma




Vocal cord dysfunction is an under-recognised condition. Its presentation often mimics asthma or severe upper airway obstruction. It is important for primary care providers who are likely to care for patients with a history of recurrent dyspnoea or wheeze to be aware of this condition.

Key Points

  • Symptoms of vocal cord dysfunction (VCD) such as sudden episodic breathlessness, wheeze and stridor can often mimic asthma.
  • Misdiagnosis of VCD is associated with high healthcare use, inappropriate therapeutic management and subsequent morbidity.
  • VCD should be suspected in patients with clinical features suggestive of asthma whose symptoms are not abated with usual asthma therapy.
  • In patients suspected of having VCD, spirometry with flow-volume curves during the symptomatic period can aid diagnosis. Variable flattening of the inspiratory curve indicates VCD.
  • The gold standard for diagnosis of VCD requires direct visualisation of the paradoxical vocal cord movement during the symptomatic period using flexible laryngoscopy.
  • The mainstays of treatment for VCD are behavioural and speech therapy, as well as management of known precipitating factors.

    Picture credit: © Top image: Poprotskiy Alexey/Shutterstock.com
    insets: Chris Wikoff, 2017