Telling the Difference Between Asthma and Vocal Cord Closure

A condition called paradoxical vocal fold motion, or PVFM, in which the vocal folds periodically close as a person inhales air, is often confused with asthma, causing patients to go months or even years without a correct diagnosis, according to 2 doctors writing for the American Academy of Pediatrics.

Caitlin Fiorillo, MD, and Nancy M. Bauman, MD, FACS, FAAP, addressed the issue this week in “Differentiating asthma from vocal cord dysfunction,” saying that raising awareness of the condition and characteristics of PVFM among primary care and emergency department physicians “will hasten diagnosis and improve management.”

They cited research that found 80% of cases are mistaken for asthma.

Although much about the onset of the condition is unknown, the physicians write that PVFM in children is believed to be related to stress; while boys or girls can develop the condition, it typically presents in preteen and teenage girls who are overachievers in school and in sports. “Sentinel events often occur during an extreme sporting event, accounting for PVFM’s frequent misdiagnosis as exercise-induced asthma,” they wrote.

Comorbidities that make PVFM worse include reflux disease and reactive airway disease.

The throat tightness and air hunger frighten parents and caregivers, who typically take the child to the emergency department (ED), even though the episodes often resolve by the time the family gets to the ED, the doctors said. But this doesn’t stop expensive tests to figure out what’s wrong, and treatments that won’t work.

Charactertistics of PVFM include a flattened inspiratory loop. The “gold standard” for diagnosis, Fiorillo and Bauman write, is flexible fiberoptic laryngoscopy during an acute episode, “where paradoxical vocal cord adduction during inspiration is seen.”

How can PVFM be treated? The doctors say speech and behavioral therapy by a licensed speech pathologist, in collaboration with a otolaryngologist is recommended, along with respiratory exercises, abdominal breathing, and “strategies to open the glottis like sniffing and breathing through pursed lips.”

A few patients may have brain abnormalities that cause the condition, they write. Stress management is also key. With greater awareness, “this enigmatic condition should be improved.”

Reference

Fiorillo C, Bauman NM. Differentiating asthma from vocal cord dysfunction. American Academy of Pediatrics. AAP News website. aappublications.org/news/2019/07/11/focus071119. Published July 11, 2019. Accessed July 12, 2019.