The Great Asthma Impostor

Exercise-induced vocal cord dysfunction can leave you gasping for air

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The Great Asthma Impostor

Right when you hit the peak of your workout, when your heart rate is high and you are breathing hard, it happens: it feels like the air has suddenly become as thick as your post-workout protein smoothie. You gasp, straining for the next breath. But Darth Vadar has a Force-like grip on your throat. You wheeze. You cough. You panic. You reach for your puffer and it helps … sort of. Your doctor has said it is exercise induced asthma, yet it seems to be getting worse. And now you’re starting to avoid those high-intensity workouts for fear you’ll stop breathing.

You may actually be experiencing exercise-induced vocal cord dysfunction (VCD). During a normal breathing cycle, the vocal cords widen with inhalation, narrow slightly with exhalation and close completely during coughing and swallowing. In VCD, the normal reflexive action of the vocal cords are disrupted and the cords come together during inhalation, restricting airflow. As VCD is often misdiagnosed, true representation of its prevalence is difficult to quantify. Retrospective studies have reported that its prevalence is anywhere between 2.5-22 per cent; with higher incidences occurring within the asthma population. Several studies have highlighted that athletes with exercise-induced VCD seem to have common characteristics of being high achievers, having real or perceived external pressures (from coaches, parents or peers) and are intolerant to personal failure.

Symptoms

Exercise-induced VCD is often misdiagnosed for asthma mainly because the symptoms are strikingly similar. However, careful review of what the athlete is reporting should give clues that further diagnostic review is required.

Exercise-Induced Asthma

  • Chest tightness
  • Difficulty getting air out; wheeze on exhale
  • Relieved by medication (i.e. Ventolin)

Exercise-Induced Vocal Cord Dysfunction

  • Tightness in the throat
  • Difficulty breathing in; hoarse sounds on inhale (stridor)
  • Not usually relieved with medication

VCD often co-exists with asthma or exercise-induced asthma. Issues such as gastroesophogeal reflux disorder (acid reflux) and post nasal drip may also be present, causing increased sensitivity within the larynx, thereby increasing the likelihood of VCD.

Diagnosis

Exercise-induced VCD is often diagnosed by exclusion, mainly due to a lack of familiarity of the condition and its mistaken identity with exercise-induced asthma. Testing, including spirometry (lung function), and laryngoscopy (camera view of the larynx and vocal cords) may help to confirm the diagnosis.

Treatment

Influence of co-existing disorders, psychological effects and breathing patterns in VCD requires an integrated approach to its treatment. This may mean pharmacological intervention for issues of reflux or sinus involvement. Daily sinus rinses may help with post-nasal drip to reduce irritation of the larynx. Education and patient counselling reduces anxiety. Letting the athlete know she is not imagining these symptoms plays a key role in alleviating fears over the condition. Relaxation training, using self-awareness and biofeedback assists in decreasing both muscle tension and anxiety. Using imagery coupled with breathing techniques often helps during acute episodes.

Breathing retraining is required to reduce the frequency and severity of acute events. Studies have demonstrated that activation of the diaphragm may facilitate contraction of muscles that help to open the vocal cords. Alternatively, shallow upper chest breathing may increase tension of the muscles in the front of the neck and throat. This tension then contributes to laryngeal tightness and spasm. Manual therapy techniques, including soft tissue massage and mobilization of the larynx may help to decrease muscle tension, but learning new breathing strategies are key to maintaining an open airway.

With practice, the athlete can learn to engage in diaphragmatic (belly) breathing at rest and with activity, and limit accessory (neck and chest) muscle use. Inspiratory muscle training, which is breathing in against a resistance, may also be helpful to reduce acute events of vocal cord dysfunction.

 

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