Medicines for Vocal cord dysfunction

What it is

Vocal cord dysfunction (now often called inducible laryngeal obstruction) is a condition in which the vocal cords, at the entrance to the airway, close or narrow abnormally when they should be open — particularly during breathing in — causing episodes of difficulty breathing. Normally the vocal cords open to let air pass; in this condition they come together at the wrong time, briefly obstructing the airflow. This causes sudden episodes of breathlessness, a feeling of tightness in the throat (rather than the chest), difficulty getting air in, and often a noisy sound when breathing in (stridor), and sometimes a cough or voice change. Importantly, its symptoms can closely resemble asthma, which means it is sometimes mistaken for asthma (or coexists with it) — but it does not respond to asthma inhalers in the same way, and recognising it prevents unnecessary escalation of asthma treatment. Episodes can be triggered by things such as exercise, strong smells or irritants, stress or anxiety, and post-nasal drip or reflux. It can be frightening, but it is not usually dangerous, and it is treatable. Recognising it — and distinguishing it from asthma — is key.

How it is treated

Management starts with recognising the condition and distinguishing it from (or identifying it alongside) asthma, which is important to avoid unnecessary asthma treatment. Diagnosis is based on the typical pattern of symptoms (throat tightness, difficulty breathing in, noisy inspiration) and, where needed, specialist assessment, sometimes including looking at the vocal cords, ideally during or provoked by symptoms. The mainstay of treatment is breathing and laryngeal control techniques, taught by a speech and language therapist (and sometimes a physiotherapist) — these teach the person to relax and control the throat and breathing during episodes, which is often very effective at reducing and managing attacks. Identifying and managing triggers helps — such as treating post-nasal drip or reflux, managing anxiety, and being aware of exercise or irritant triggers. Reassurance is valuable, as the episodes, though frightening, are not usually dangerous, and understanding the condition reduces the fear that can worsen it. Any coexisting asthma is treated appropriately. The reassuring message is that vocal cord dysfunction, although it can mimic asthma and be alarming, is treatable — often very effectively with breathing techniques from a speech and language therapist — and that recognising it prevents unnecessary asthma treatment.