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.

2 thoughts on “Vocal cords and asthma”

  1. It’s interesting that you mention bacterial origin of ulcers. Because Barry Marshall who made that discovery fought for years to convince big pharma that cheap antibiotics could treat ulcers rather than billion-dollar blockbuster drugs. It’s not that it’s become dogma now, it’s just that if you present with ulcer symptoms they test for Helicobacter pylori first, if you’ve got it they treat with a couple of weeks of antibiotics rather than putting you on Zantac for the rest of your life. Surely, that’s the best option!

    But, yes, I agree GPs should be more holistic, and indeed, I’d say my recent experience with them is that they are, they *do* ask about lifestyle and other symptoms, they don’t fob you off with a scrip and a wave of the hand as they stereotypically may have done in the past. I think GPs are far more aware of the pressures to save money so don’t accede to the pharma reps and that’s actually been of benefit to patients because they can write more “green” prescriptions and suggest lifestyle and diet changes that will likely benefit many…

    It’s not perfect, but what is?

  2. This sounds like another case of herd mentality in medicine; once a diagnosis or condition has been rationalized, thinking stops and habit takes over. E.g. acceptance of a bacterial origin for ulcers, formula feeding of babies, DES during pregnancy, statins for heart disease, PSA for prostate disease, etc. These diagnosis/treatment situations all had rational origins but quickly evolved into dogma, with alternatives receiving minimal attention. I find it difficult to totally fault the physicians who handle the everyday diagnosis/treatment decisions we all receive, given our increasingly complex biomedical landscape, but believe we would all benefit from fewer automatic responses and more patient-specific thinking. A lot less influence from commercial interests would also be a big positive change.

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