Asthma and vocal cord dysfunction (VCD) are strikingly similar in symptom presentation, but one subtle difference can point much more to vocal cord dysfunction.

Ever have an episode of VCD?

Perhaps you chalked it up to just getting something caught in your throat while exercising.

However, that may very well be what triggered your vocal cords to go into spasm and make you feel as though your windpipe was the size of a straw.

Vocal cord dysfunction may occur extremely infrequently, or commonly in athletes prone to it. Exercise induced asthma will occur more regularly.

“Asthma is abnormal narrowing and swelling of the lower airways due to an immune response that produces inflammation,” says Angel Coz, MD, FCCP, board certified pulmonologist, Associate Professor of Medicine, University of Kentucky, Lexington Veterans Affairs Medical Center.

“Exercise induced asthma (EIA) is triggered by exercise. Vocal cord dysfunction is an abnormal closing of the vocal cords when the patient breathes in or out.

“VCD can be confused with asthma, as they share similar symptoms like shortness of breath, chest and/or throat tightness, wheezing, chronic cough, hoarseness, among others.

“Moreover, VCD can have similar triggers as asthma like breathing lung irritants, exercise or infection.”

The tricky thing about vocal cord dysfunction is getting a confirmation that you had an episode.

“A breathing test like spirometry will commonly be normal in patients with VCD when they are not experiencing symptoms,” says Dr. Coz.

“However, the test can be very useful in making the diagnosis of VCD when the symptoms are occurring. The test must include flow volume loops to be useful.”

I’ve been exercising for most of my life. One day I was doing incline intervals on a treadmill, breathing in the unpleasant odor of the recent renovations of the gym.

After a work interval at 15 percent incline, I set the machine to zero grade. While it was lowering, and while my body was recovering, I suddenly had to cough.

Instinctively I knew that once the cough would end, I’d have trouble breathing. And sure enough, that’s exactly what happened.

The experience was frightening as I continued walking. As hard as I inhaled, I just couldn’t get in enough air, and it felt as though my entire airway were as thin as a straw.

The inhalations were slow and labored, from bottom to top, and still I was short of breath—though not “out of breath.”

That’s the weird thing. It felt like a mechanical issue, not an out-of-breath issue. Remember, I was in recovery mode, with the incline lowering.

And the intensity of the work interval had only been moderate level. I was fit as a fiddle and to this day, swear that this was a VCD episode.

After about 20 seconds it started getting easier to inhale.

Because I had ear plugs in, and because the gym was noisy, I didn’t hear any wheezing, though a wheezing sound is a common symptom with vocal cord dysfunction.

After the incident I did a workout with a weighted sled—far more strenuous—without incident.

My theory is that I had inhaled a particulate, or as Dr. Yataco pointed out, a lung irritant, from the renovations, and that it had triggered my vocal cords to spasm (close). Vocal cords are muscles.

Another time, years before that, I was briskly walking outside in an industrial section of town in the middle of the night, on lunch break from a third shift job.

The air stunk of chemicals, and soon into the walk, I found it difficult to breathe.

It was so unsettling that I immediately turned back from where I came, assuming that the difficulty with inhaling was caused by airborne dust. But at the time, I knew nothing about vocal cord dysfunction.

Is there a way to tell the difference between vocal cord dysfunction and exercise induced asthma?

Dr. Coz explains, “A very subtle difference that may not be apparent to many patients is that VCD typically makes it harder to breathe in than to breathe out when the symptoms worsen. The reverse is typically more frequent in asthma.

“VCD will typically not respond to asthma medication like bronchodilators. The treatment for VCD includes speech therapy.”

Dr. Coz is a pulmonary and critical care specialist at the Lexington Veterans Affairs Medical Center. He has a special interest in sepsis resuscitation and medical education. 
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: Shutterstock/Aaron Amat