Vocal Cord Dysfunction Case Study

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Have you ever had a patient with difficult to treat asthma? The national heart, lung, and blood institute (NHLBI) guidelines for the diagnosis and management of asthma specifically recommend considering the diagnosis of vocal cord dysfunction in patients who fail to respond as expected to asthma. This paper will give some brief background information on VCD, explain the mechanics of vocal cord dysfunction, possible causes, differential diagnosis between asthma and VCD, management, and a case study done involving military personnel.
In the 1970s, VCD was termed Munchausen stridor and was believed to be primarily a result of somatization and emotional stress. In literature, VCD is also referred to as paradoxical vocal cord movement disorder, …show more content…
A patients past medical history should include presence of dysphagia, stroke, brain tumor, head injury, vocal cord paralysis, and use of psychiatric medications. Although asthma and VCD have similarities generally, patients with VCD lack sputum production and nocturnal symptoms and have localization of wheezing to the throat and upper part of the chest. In addition they have no significant abnormalities with blood gases, echocardiography, chest radiography, pulmonary artery pressures, alveolar-arterial oxygen differences and will not demonstrate significant reversibility as you would see with patients with asthma (Cline, E 2006) As far as pulmonary function testing is involved patients with VCD often demonstrate a truncated or flattened inspiratory flow volume loop with an otherwise normal test. The use of flow volume loop is commonly used to support the diagnosis of this condition but it does not provide a definitive diagnosis because abnormal inspiratory flow loops may also be the result of poor patient effort (Cohen, S. M. (2010). Methacholine challenge testing and exercise challenge testing also assist in the diagnosis of some patients but can result in a false positive for asthma 22% of the time. Inhaling methacholine may cause severe bronchospasm and coughing, making it difficult to interpret the results in a patient suspected of VCD. Exercise challenge testing is occasionally obtained and is useful in ruling out exercise- induced bronchospasms and may detect VCD induced by exercise. Protocols vary but most begin with stretching and two minutes of walking; then patients run on the treadmill until they either are unable to continue, reach a target heart rate set by the administrator, or have a bronchospasm. Spirometry testing
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