Page 13 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 13
Dysfunctional Breathing 1.1
– View of Otorhinolaryngologist
Maja Šereg Bahar 1, 2
Abstract 1 University Medical Centre
Background. Dysfunctional breathing – vocal cord dysfunction (VCD) or paradoxical vocal Ljubljana, Ljubljana, Slovenia
fold movement (PVFM) is inappropriate vocal fold movement. Adduction of the vocal folds
appears during inspiration, resulting in d yspnea and inspiratory and sometimes expiratory 2 Faculty of Medicine,
stridor, and acute upper airway obstruction. It is a functional disorder, an important mimicker University of Ljubljana,
of asthma, leading to unnecessary morbidity and high medical utilization, unnecessary drug Ljubljana, Slovenia
use, and high-dose corticosteroid use. The gold standard test for diagnosis of VCD is direct vis-
ualization of the vocal folds by laryngoscopy while a patient has symptoms or is combined with
special m aneuvers that trigger symptoms.
Methods. The recent papers on vocal cord dysfunction were reviewed.
Results. VCD is an important differential diagnosis of refractory asthma, that is widely unrec-
ognized. But concomitant vocal cord dysfunction and asthma are seen in a high degree of pa-
tients, up to 50%. VCD is a benign and self-limiting disorder and there are no long-term se-
quelae. Correct diagnosis is important due to proper treatment. The cornerstone of the VCD
treatment is speech therapy like respiratory retraining, learning breathing techniques, and dif-
ferent maneuvers that enable quick release of symptoms. Psychotherapy and hypnosis are im-
portant modes of treatment as well. Medications and botulinum toxin are used rarely.
Conclusions. We should suspect VCD in patients with asthma-like symptoms that do not re-
spond to conventional asthma therapy or are induced by stress and exercise. A team of differ-
ent specialists is necessary to find the correct diagnosis and proper treatment.
Keywords: dyspnea, v ocal cords dysfunction, speech, and language therapy, maneuvers
Introduction presenting mainly during inspiration leading
to dyspnea of varying intensity21.
More than 70 terms have been used to de-
scribe the abnormal movement of the true vo- Epidemiology
cal cords. The two most encountered terms in The overall incidence of VCD in the gener-
medical literature are paradoxical vocal fold al population is not well defined, because of
motion (PVFM) and vocal cord dysfunction the lack of uniformity in definitions and di-
(VCD)9. PVFM/VCD is a condition charac- agnostic criteria for VCD. The incidence is
terized by abnormal adduction of the vocal underappreciated in clinical practice. Preva-
folds during inspiration, leading to episodic lence has been reported to range from 2.5%
dyspnea, wheezing, and stridor23. VCD is an of patients presenting to an asthma clinic to
intermittent extrathoracic airway obstruction
https://doi.org/10.26 493/978 -961-293 -297-8.13 -22
– View of Otorhinolaryngologist
Maja Šereg Bahar 1, 2
Abstract 1 University Medical Centre
Background. Dysfunctional breathing – vocal cord dysfunction (VCD) or paradoxical vocal Ljubljana, Ljubljana, Slovenia
fold movement (PVFM) is inappropriate vocal fold movement. Adduction of the vocal folds
appears during inspiration, resulting in d yspnea and inspiratory and sometimes expiratory 2 Faculty of Medicine,
stridor, and acute upper airway obstruction. It is a functional disorder, an important mimicker University of Ljubljana,
of asthma, leading to unnecessary morbidity and high medical utilization, unnecessary drug Ljubljana, Slovenia
use, and high-dose corticosteroid use. The gold standard test for diagnosis of VCD is direct vis-
ualization of the vocal folds by laryngoscopy while a patient has symptoms or is combined with
special m aneuvers that trigger symptoms.
Methods. The recent papers on vocal cord dysfunction were reviewed.
Results. VCD is an important differential diagnosis of refractory asthma, that is widely unrec-
ognized. But concomitant vocal cord dysfunction and asthma are seen in a high degree of pa-
tients, up to 50%. VCD is a benign and self-limiting disorder and there are no long-term se-
quelae. Correct diagnosis is important due to proper treatment. The cornerstone of the VCD
treatment is speech therapy like respiratory retraining, learning breathing techniques, and dif-
ferent maneuvers that enable quick release of symptoms. Psychotherapy and hypnosis are im-
portant modes of treatment as well. Medications and botulinum toxin are used rarely.
Conclusions. We should suspect VCD in patients with asthma-like symptoms that do not re-
spond to conventional asthma therapy or are induced by stress and exercise. A team of differ-
ent specialists is necessary to find the correct diagnosis and proper treatment.
Keywords: dyspnea, v ocal cords dysfunction, speech, and language therapy, maneuvers
Introduction presenting mainly during inspiration leading
to dyspnea of varying intensity21.
More than 70 terms have been used to de-
scribe the abnormal movement of the true vo- Epidemiology
cal cords. The two most encountered terms in The overall incidence of VCD in the gener-
medical literature are paradoxical vocal fold al population is not well defined, because of
motion (PVFM) and vocal cord dysfunction the lack of uniformity in definitions and di-
(VCD)9. PVFM/VCD is a condition charac- agnostic criteria for VCD. The incidence is
terized by abnormal adduction of the vocal underappreciated in clinical practice. Preva-
folds during inspiration, leading to episodic lence has been reported to range from 2.5%
dyspnea, wheezing, and stridor23. VCD is an of patients presenting to an asthma clinic to
intermittent extrathoracic airway obstruction
https://doi.org/10.26 493/978 -961-293 -297-8.13 -22
