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?