Diagnosed with Asthma, but an Inhaler Isn’t Helping?

Diagnosed with Asthma, but an Inhaler Isn’t Helping?

June 25, 2019

Clinical Contributors to this story:
A. Bettina Lopez-Lam, MS, CCC-SLP

Having trouble breathing is always a scary experience. But if you’ve been diagnosed with asthma, and your inhaler doesn’t help during these attacks, it can be frustrating, too.

Patients experiencing asthma symptoms can be misdiagnosed when in fact they are suffering from vocal cord dysfunction (VCD).

VCD is an abnormal narrowing of the larynx. “It’s a dysfunction of the vocal cords where the cords actually close up when a patient breathes in, making the patient feel like they can’t breathe in and are being strangled,” says A. Bettina Lopez-Lam, MS, CCC-SLP, senior speech-language pathologist, Bayshore Medical Center.

VCD causes many of the same symptoms as asthma:

  • Shortness of breath
  • Wheezing
  • Chronic cough
  • Chest and throat tightness
  • Trouble breathing

But the hallmark of VCD compared to asthma is trouble getting air in and tightness that feels like choking or suffocation.

What Causes Vocal Cord Dysfunction?

Common triggers that cause VCD include high-intensity exercise, postnasal drip and reflux. “My primary VCD caseload consists of either respiratory patients, anxiety-ridden patients or athletes,” Bettina says.

Oftentimes, VCD attacks occur in high-stress situations, like when an athlete is training for a high-profile competition or being recruited to compete at the collegiate level. “If you have a lot of anxiety on your plate, it can be more difficult to remember to relax, breathe properly using the diaphragm and keep your body up straight,” Bettina says. “Not doing these things can create upper-body tension and bring on VCD.”

VCD patients misdiagnosed with asthma often see their symptoms improve at first by using an inhaler. “But the inhaler is causing a placebo effect,” Bettina says. “You relax because you think the inhaler is working, which reduces anxiety and helps you breathe properly. But eventually that inhaler isn’t going to work.”

Bettina thinks she may have experienced VCD as a child. “I was the one who could never run the mile in gym class,” she says. “Inhalers didn’t help, and doctors kept calling it asthma. Years later, after I learned proper breathing techniques, I can do cardio without any problems.”

How Vocal Cord Dysfunction Is Treated

With VCD, medications do not help. Only a specific relaxation regimen and breathing techniques can heal it.

Bettina’s typical treatment plan for VCD patients begins with an evaluation, where she asks questions to understand a patient’s anxiety and stress level. “I try to see what situations might have led to the VCD symptom flareup,” she says. “I also watch them as they’re talking to me to see their posture and I feel their upper-body muscles.”

During subsequent sessions, Bettina teaches stretches and massages to help with relaxation, and shows proper breathing techniques where breathing is focused from the diaphragm. For athletes, she might even take them for a run outside or on a treadmill to put these techniques to practice.

Typically VCD can be treated in two to six weeks, depending on the patient.

How to Prevent Vocal Cord Dysfunction

VCD can reoccur in patients who have gone through treatment. “But prevention is all about behavioral changes—remembering to relax, keep your body up straight and use your diaphragm to breathe,” Bettina says. “VCD symptom flareups can happen again, but usually patients just need a reminder of the techniques they’ve learned.”

Next Steps & Resources

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

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