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Vocal Cord Dysfunction (VCD) is a cause of shortness of breath and wheezing that is often confused with asthma. It is caused by paradoxical movement of the vocal cords during inspiration and expiration. Normally the vocal cords separate or open during inspiration and expiration to allow air in or out of the lungs. With VCD, the vocal cords close with inspiration. This is associated with airway obstruction that can be measured with a spirometer.

The results can be confounded with asthma, which also causes airway obstruction, but the flow-volume loop usually reveals the correct diagnosis. Since there is no lower airway obstruction, there is a poor response to treatment with asthma medications. Patients are usually labeled as severe, steroid resistant asthmatics when the the problem may ultimately be vocal cord dysfunction.

There is is an intimate association of laryngopharyngeal acid reflux (LPR) with VCD. LPR may cause chronic laryngeal inflammation which cause the vocal cords to be hyper-reactive and possibly develop laryngeal spasm.

The gold standard for diagnosing VCD is to visualize the paradoxical movement of the vocal vocal cords during the respiratory cycle with a rhinolaryngoscope. Unfortunately, the exam may be normal between attacks. VCD usually improves with antacid therapy, and in some cases, speech therapy.