Vocal Cord Dysfunction
If a patient is presumptively diagnosed with VCD but fails to respond to therapeutic sedation, re-consider whether the patient could have an alternative, life-threatening cause of upper airway obstruction - Josh Farkas
HWN Suggests
Vocal Cord Dysfunction
In general, VCD should be a diagnosis of exclusion in the ED – the risk of missing something more life threatening is high and none of us should be too cavalier about making this diagnosis in someone who does not already have confirmed VCD by laryngoscopy and PFTs. However, there are features that may suggest it.
Featured
Learning to Diagnose VCD
Even though much has been written about VCD in the medical literature, many VCD patients are not being correctly diagnosed when they go to emergency departments (or call for an ambulance). They are often gasping for air or unable to inhale at all, becoming hypoxic and fearing for their lives. VCD patients are usually misdiagnosed as having asthma or hysteria, and are sent on their way, often with Albuterol, even when they don't have asthma.
Articles of Interest
The forgotten cause of stridor in the emergency department
When a patient with stridor presents to the emergency department (ED), the most probable differential diagnosis that comes to mind would be vocal cord paralysis, organic upper airway obstruction (tumor, abscess, infections, and allergic reaction), or a foreign body in the airway. An unusual, but possible, cause of stridor in these circumstances could be paradoxical vocal fold movement disorder (PVFMD).
Vocal Cord Dysfunction Is a Puzzling Asthma Mimic
Acute respiratory distress is an unnerving incident for both patients and emergency care providers, especially when the cause isn’t known and the care provided fails to relieve symptoms. Vocal cord dysfunction (VCD), also called paradoxical vocal fold motion, is one of those unsettling conditions.
Vocal Cord Dysfunction: A Frequently Forgotten Entity
The true prevalence of VCD is unknown since there have been no prospective cohort studies to assess the development of new cases and many reports lack adequate diagnostic criteria.
Vocal Cord Dysfunction: A Pernicious Pitfall in Asthma Diagnosis and Treatment
The old adage, “Not all that wheezes is asthma,” attributed to physician Chevalier Jackson (1865-1958), has never been more relevant than today, given reports that at least 30% of physicians’ asthma diagnoses are incorrect.
Vocal Cord Dysfunction: Unmasking the Asthma Pretender
The symptoms of vocal cord dysfunction (VCD) can be mistaken for those of asthma or other respiratory illnesses. As a result, VCD is often misdiagnosed, leading to unnecessary, ineffective, costly, or even dangerous treatment. Here are the facts that will enable you to avoid making an erroneous diagnosis, choosing potentially harmful treatment, and delaying effective treatment.
Vocal cord dysfunction: what do we know?
Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial.
Resources
EmCrit
Patients with VCD (or other upper airway problems) often present with easily audible stridor and/or expiratory wheeze. This is often very dramatic and scary. Alternatively, in patients with severe asthma this shouldn't be audible from across the room. In fact, patients with severe asthma may have a totally quiet chest (even with a stethoscope).
