It’s Not Asthma? Vocal Cord Dysfunction and Running

After quitting the track team in high school due to what she thought were asthma attacks, Laura Hurd started running again as an adult, but soon the attacks came back. Now a speech-language pathologist, she recognized that the symptoms she was experiencing way back when were not asthma but something else — vocal cord dysfunction.

Our vocal cords are designed to block our airways when we swallow to keep food and drink out from going down the wrong pipe and into our lungs. When operating normally, vocal cords only block our airways for that purpose. Paradoxical vocal cord dysfunction, also known as vocal cord or vocal fold dysfunction (we’ll call it VCD), occurs when the vocal cords close when breathing, and thus block the airway. It’s obviously a problem when breathing causes us not to be able to breathe! 

VCD is more common than you’d think and is exacerbated by environmental irritants (hello, urban marathons), upper respiratory infections, acid reflux, and anxiety. The stress of not being able to breathe can make an attack worse. VCD occurs in children and adults, most often in women and girls. It’s relatively common in athletes and is often linked to psychiatric disorders like depression and anxiety.

Laura, the speech therapist, said that feeling emotional is a big trigger for her, recalling her recent half marathon:

As I was running I was thinking about my family and the process in which I have come this far. And I started to get emotional. And then as soon as I saw my husband when I came around the corner I lost it and had an attack. Now I know for myself I cannot think about emotional things when I’m running.

It can be challenging to get an accurate diagnosis; when presented with a patient complaining that they sometimes feel like they can’t breathe, most doctors are quick to diagnose asthma and send them to pick up an inhaler. One subtle difference between asthma and VCD is that VCD generally presents with difficulty breathing in, rather than out. VCD may feel more like an upper airway constriction rather than the chest tightness of asthma. However, many times VCD is diagnosed only after a patient has experienced no improvement of symptoms using asthma medications.

Symptoms of Vocal Cord Dysfunction

      • Feeling short of breath or that it’s hard to get air into or out of your lungs
      • A feeling of tightness in the throat or chest
      • Frequent cough or clearing your throat
      • A feeling of choking or suffocation
      • Noisy breathing (wheezing or raspy sound)
      • Hoarse voice

    credit: Cleveland Clinic

So what is the treatment for VCD?, you ask. Here’s where your friendly neighborhood speech-language pathologist comes in! Speech therapy may work on breathing techniques with and without producing voice or specific sounds, muscle control and rescue techniques, education on normal and abnormal vocal cord movement, elimination of vocal abuses, and mental coping responses that can all help prevent attacks.

Sometimes mental health or medical co-treatments are needed, especially in the case of co-existing anxiety disorder or asthma. Generally, however, a little speech therapy on its own is very successful.

Any runners out there with VCD? How do you deal with breathing issues?

I'm a 20-year veteran of competitive running, USATF certified coach, mom of a toddler -- and still trying to set PRs. I write about training from 5k to marathon, motherhood and competitive running, and the elite side of the sport. The 5k is my favorite race (16:56 PR) but I've got a score to settle with the marathon.

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  1. My VCD is secondary to my acid reflux. In the spring of 2015, I was training for a marathon with three shorter races leading up to it. I live in Louisville, Ky., which has been ranked as the country’s second worst city for allergies. Basically EVERYONE has seasonal allergies. Spring rolls around and everyone’s eyes are all puffy. I had been allergy tested in the early 2000s, and had shown response to a few things but nothing really major. (I had been getting frequent sinus infections.)

    So I’m training for these races in 2015, and it’s March and I’m having trouble breathing while I’m running. Feeling like I couldn’t get air into my lungs. I had been taking OTC Claritin generic for years, and my doctor added a nasal spray I had used before, and gave me an inhaler and an another prescription allergy med. Like Catnip said, the allergy diagnosis seemed like a straightforward and easy solution for this part of the country and for the symptoms I reported.

    By now, I had four allergy medicines to take daily. And they weren’t helping. At that point my primary doc sends me to an allergist to see what’s going on. I’m wondering if I’ve developed some sort of exercise-induced asthma. They do the full battery — a panel of tests on my back and then a second panel on my arms — and I have absolutely no histamine reactions. Even less than I did when I was tested the first time! They have me do a breathing test where I have to blow out a candle on a screen.

    Allergy doc comes in after all the tests are done, and asks, “Is it hard to breathe in or breathe out?”

    And I’m like, “Duh. Breathe in.”

    “Well, it’s definitely not asthma then. I’m pretty sure what you’ve got is acid reflux and irritated vocal chords and that a little purple pill every day will fix you right up.”

    He referred me to an ENT who confirmed the diagnosis. Now I take omeprazole and my vocal chords work fine!

    (And I don’t have to take any of the allergy meds!)

    Also to Catnip’s point, I had a referral to a speech pathologist if the omeprazole didn’t rectify it.

    The information about anxiety and emotion are really interesting to me, too! I’ll be cognizant of that in the future and see if I notice anything.

    1. Thanks for sharing your story here, Chicory! I’m glad you didn’t go too long with the misdiagnosis (and unnecessary meds)! Do you ever have episodes anymore?

  2. I notice this weird feeling like tightness in my upper respiratory tract at the end of some long runs or hard workouts, particularly if I’m struggling or tired and really want to be done. I wonder if the little bit of anxiety that goes along with the physical exhaustion is causing this?! It sounds exactly like this feeling.

  3. I was diagnosed with VCD about 5 years ago after being misdiagnosed for several years with asthma (inhalers never helped). I went through months of therapy at the Mass General Voice Center and haven’t had an issue since. It’s really important to work with someone who is familiar with VCD. My therapy included painful massage on the front of my neck and the region around my hyoid bone, video of my vocal cords opening and closing (camera down the back of my throat), breathing techniques, and my therapist actually accompanying me on runs, waiting for me to start “wheezing” and immediately intervening with different therapy techniques (massage, nasal breathing, etc.).

    I also had a history of reflux which I “cured” by going gluten-free. PPIs like omeprazole, though effective in treating reflux, also affect the body’s ability to absorb vitamins and minerals so can be problematic long term. I had been eating Ezekial bread (sprouted grain) toast daily, thinking that was healthy, but as soon as I cut that out and all other forms of gluten I haven’t had ANY heartburn whatsoever! I try to spread the word on this because I was so amazed that gluten was actually causing my reflux symptoms all along. (And this was even after an upper GI series showed mild reflux)

    1. Oh wow, thanks for sharing. I am actually a speech therapist myself, but I wouldn’t touch a case of VCD because (like you said) you really need someone with specific training and experience. I’m glad you’ve figured out all those health issues!

    2. First, I’m 70. For years, off and on, tried running and experienced what was diagnosed as EIA. Inhalers ineffective. 2 years ago, training for my first tri, throat closed repeatedly again. I managed to get thru the tri and about a mile before finishing the 4 mi., throat closed. Fast forward 2 years, tri club had a beginner running clinic, using run/walk technique. Made it all the way up (!) to running 1 minute 8X without incident. As soon as the run time ramped up, throat closed. Each time, relieved when I sat down, jutted my chin out (for nurses out there – think ‘child with epiglottitis’). My daughter-in-law, who’s a physician, said ‘no brainer – VCD’. Went to my PCP, who said same thing. Never happens when I swim (I do about 1.25 mi 3-4X/wk) or cycling. PCP suggested visiting ENT for laryngoscopy. No thanks! I’m 70 and made it this far without running! I will be repeating the Malibu Tri next year (at age 71) – only my second tri – and plan to swim, bike, and….walk!

  4. I had no idea this could even be linked to breathing with running. It makes you wonder how many times doctors diagnose something incorrectly, or just place you on more meds assuming you just have a really bad case of asthma. Like when I went to a podiatrist a few months ago, the dude was obviously in such a huge rush. I told him I was having pain in my foot and kind of pointed to where it was located; he didn’t ask me any other questions and said that it was PF without even examining it. I also asked him how to prevent ingrown toenails, and he told me to “stop getting pregnant.” Needless to say, I never went back to him again. But it’s interesting that they have to r/o asthma first, and then link your symptoms to something more, like VCD! Thanks for the great medical read 🙂

  5. I was also misdiagnosed with exercise-induced asthma as a child, but had to quit sports altogether with inhalers just not really working and routinely blacking out on the field. Fast forward to adult life I was finally diagnosed by an ENT via scope of having VCD and in-turn referred to a speech therapist. Unfortunately, about a month of speech therapy, breathing exercises and such and my speech pathologist was out of ideas as my VCD/asthma seems to be self-aggravating through exercise. We tried a variety of methods to prepare me for runs but the only thing I’ve managed to get to work is solely breathing in through my nose, which goes out the window in intense exercises that require large gasps of air.

    I’ve really been hoping there would be some breakthroughs in treating the combination of asthma/VCD, but have yet to see much.

    I did see a study from 2010 that noted a high prevalence of asthma + VCD combination in sufferers: