Vocal Cord Dysfunction Symptoms
Vocal cord dysfunction presents with intermittent shortness of breath, inspiratory stridor, throat tightness, and choking sensations that occur during activity and resolve rapidly with rest—symptoms that peak during rather than after exercise, distinguishing it from asthma. 1
Primary Respiratory Symptoms
- Dyspnea (shortness of breath) that is intermittent and variable in intensity, typically occurring during exercise or exposure to triggers 2, 3, 4
- Inspiratory stridor with throat tightness during maximal exercise that resolves within approximately 5 minutes of stopping activity 1
- Wheezing that may be audible but differs from asthma in its inspiratory rather than expiratory predominance 2, 4, 5
- Chest tightness that patients often describe as a sensation of airway obstruction 3, 4
Laryngeal and Throat Symptoms
- Throat tightness or choking sensation that is a hallmark differentiating feature 1, 2, 3
- Voice changes or hoarseness occurring intermittently during symptomatic episodes 2, 4
- Sensation of a lump in the throat (globus sensation), which may co-occur with VCD as part of laryngeal hypersensitivity syndrome 1
- Chronic cough that can be a manifestation of laryngeal hypersensitivity syndrome, of which VCD is considered a component 1
Timing and Trigger Characteristics
- Symptoms peak during exercise rather than 5-20 minutes after exercise (as occurs with exercise-induced bronchoconstriction), which is a critical distinguishing feature 1
- Rapid resolution of symptoms within minutes after cessation of activity or with relaxation 2, 4
- Triggered by exercise, psychological stress, airborne irritants, rhinosinusitis, or gastroesophageal reflux disease 4, 6
- Symptoms occur in response to salient stimuli as part of a conditioned response, with or without perceived panic or autonomic arousal 1
Key Diagnostic Clues
- Failure to respond to asthma medications (beta-2 agonists, inhaled corticosteroids) is a critical historical feature suggesting VCD rather than asthma 1
- Variable flattening of the inspiratory flow loop on spirometry during symptomatic periods, contrasting with the expiratory flow limitation seen in asthma 1, 5
- Symptoms are inconsistent with severity of any underlying structural pathology and may resolve completely between episodes 1
Common Pitfalls
The most important caveat is that VCD frequently coexists with asthma (occurring in up to 20-40% of cases), making diagnosis challenging and requiring clinicians to maintain suspicion even in patients with confirmed asthma who have atypical or refractory symptoms 1, 3, 6. VCD is particularly common in young adult female elite athletes and middle school to high school-aged athletes, where it is often misdiagnosed as exercise-induced asthma 1, 2. The diagnosis requires direct visualization of paradoxical vocal cord adduction during symptomatic periods via flexible laryngoscopy, as symptoms and examination findings are typically normal between episodes 2, 3, 6.