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Vocal cords and asthma

A diagnosis of exercise-induced bronchospasm – asthma – is commonly given to patients who present with cough, breathlessness and wheeziness after exertion despite being otherwise physically fit. An alternative explanation to bronchial (airways) constriction was discussed on BBC Radio 4’s Inside Health this week on which they suggested that vocal cord dysfunction might be to blame as the vocal folds close over the airway in susceptible individuals

Thus physiotherapy and breathing exercises rather than asthma medication might be a better intervention for many sufferers (unless they also have underlying asthma). It does rather suggest that asthma might be being over-diagnosed. It also hints that yoga, singing and other techniques that teach better posture and breathing may actually have a genuine mode of action if they can control the constriction of one’s vocal folds. Perhaps even Buteyko techniques have a place, for this form of breathing problem.

Intriguingly, a quick PubMed search turned up a paper from 1996 on seven elite athletes with psychogenic vocal cord dysfunction who presented with apparent exercise-induced asthma that was nothing of the sort. The study’s conclusion is that “The mere association of exercise and airway obstruction is not sufficient to establish the diagnosis of asthma.”

That was 1996…why are we only now learning about this issue and the potential differential diagnosis for exercise-induced breathing difficulties. If your or your child’s physician offers asthma meds for those after-sport symptoms ask whether vocal cord dysfunction might be to blame.

There is actually no real, definitive test for asthma, peak flow meter before and after inhaled salbutamol seems to be the usual way. However, there is a way to diagnose exercise-induced vocal cord dysfunction using trans-nasal endoscopy.

Vocal cord dysfunction masqueradin… [Am J Respir Crit Care Med. 1996] – PubMed – NCBI.

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