I intend and hope, to exercise as long as my body is able and willing. Fortunately we live in San Diego where there are no bad days.
Most of us need at least 6 hours of exercise a week. If you have a pedometer, that’s 10,000 steps a day. Many people cannot live without their Zumba classes, their daily 5 mile run, or Golf games. For kids and teenagers, its competitive soccer, or club swim meets, or ice skating.
What happens when you just cannot get enough air???
In 1951 the medical literature reported patients that presented with factitious asthma and irritable larynx. They were thought to be “lying” about their breathing problems. But in 1983, a group of patients who were said to have “uncontrolled asthma” were seen by a multidisciplinary team of medical professionals at national Jewish Health, at which point they were correctly diagnosed with Vocal Cord Dysfunction (VCD), or Paradoxical Vocal fold Motion (PVFM). This condition causes the vocal cords to close abnormally when you breathe in and out. This closure makes it harder to get air into or out of your lungs. Think of the type of twitching you can get from time to time with your eyelids when you are too tired, or had too much caffeine. Same type of twitching can happen in your throat, around your Vocal cords. Typically you are not even conscious about such motions, but what you will feel are the following:
- Feeling short of breath or feeling that it is hard to get air into or out of your lungs.
- A feeling of tightness in the throat or chest.
- Frequent cough or clearing your throat.
- A feeling of choking or suffocation
- Noisy breathing (wheezing or raspy sound/stridor)
- Hoarse voice
An attack of VCD can be sudden and may be severe. Without treatment, a severe attack may require emergency room treatment, frequently diagnoses as asthma, with over use of steroids orally and inhaled. Even if an attack is severe however, the oxygen level in your blood is usually normal. VCD symptoms do not usually occur during sleep.
What can cause VCD?
There are many different possible causes of VCD, and at times no cause can be found.
- Upper respiratory infection (cold)
- Strong odors or fumes
- Tobacco smoke
- Post-nasal drip
- Acid reflux (GERD)
- Strong emotions and stress
- Exercise
How do I know if I have VCD?
VCD can be very hard to detect. Often people with VCD are thought to have asthma because the symptoms and triggers for VCD and asthma can be similar. The difference between VCD and asthma is that if you have asthma, medicines that open your breathing tubes (bronchodilators like albuterol) will improve your breathing. If you have VCD alone, the bronchodilator will not work. To make it even more confusing, you may have both VCD and asthma.
Your healthcare provider can find out if you have VCD by testing your breathing and looking at your vocal cords. The breathing test is called spirometry and must include a flow-volume loop. This test shows how well air moves in and out of your lungs. If you are having VCD symptoms during the test, the test will usually, but not always, show blockage mainly of the air flowing into the lungs. Breathing test results are often normal if your VCD is not active at the time of testing. This is one reason why it can be hard to determine if you have VCD.
The best way to tell if you have VCD is for your Allergist or ENT to see your vocal cords when you are having difficulty breathing, via a flexible fiberoptic tube (laryngoscope) passed through your nose to the back of your throat where your vocal cords can be seen. This is an outpatient test, you are awake, and you may be asked to talk to see if your vocal cords are working normally.
You may be asked to exercise on a treadmill before the testing to try to bring on the VCD symptoms. If symptoms develop, a breathing test or laryngoscopy will be done to confirm the abnormal closure of the vocal cords.
How is VCD treated?
VCD is different than many other breathing problems because medicines are not the main treatment to control or prevent VCD.
- The main treatment for VCD is speech therapy techniques that help you learn to control your vocal cords.
o Speech therapy techniques are usually taught by a speech therapist or psychologist who is trained and experienced in treating VCD.
o The techniques you will learn will help to improve your ability to relax your throat muscles.
o You may have to meet with a therapist at least three to four times to learn these techniques.
o Learning these techniques takes regular practice. You will need to practice them even when you are not having VCD, so you can be ready to control the symptoms before they become severe.
- Strong emotions and stress can trigger VCD, so it is important to learn to manage your stress. Relaxation techniques, biofeedback, and psychotherapy have been shown to be helpful in controlling VCD.
- If you have asthma and VCD, it is important that your asthma is under good control.
- If your VCD is triggered by post-nasal drip or acid reflux (GERD), it is important to talk to your healthcare provider about what you can do to control these.
Maryam Zarei MD FAAAAI