Cough Variant or Vocal Chord Dysfunction?

I know both these subjects have been discussed at length in the past, but I'd like to hear from people who have either of these as I'm trying to self-diagnose!

Sometimes I seem to wheeze when breathing in, and it feels like my chest is clear, but my throat is narrow - so this doesn't seem like asthma. Taking my inhaler has little or no effect, so I just tend to try and ignore it and it goes away after about 30 minutes or so.

Other times (like tonight) I get a very annoying cough which I don't register as an attack of asthma because its not really accompanied by a wheeze, but usually if I make a big deep breath out, I can hear/feel a little bit of a wheeze right at the end. My peak flow appears normal, but taking two puffs of salbutamol makes the symptoms disappear.

Other times I get the works - cough, wheeze, breathlessness - what I would actually recognise as asthma.

Weird? Or normal?

3 Replies

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  • Hi Spaniel,

    The experiences you are describing are quite normal. It's fairly common to have a mixture of these things - coughing can be a common symptom, with or without wheeze, and vocal cord dysfunction can often co-exist with asthma. It can be very difficult to untangle all the separate elements.

    It's hard to know without knowing more about it or actually seeing it happen to you, but I would suggest that the 'throat' feelings with inspiratory wheeze, that don't respond to salbutamol, are more likely to be a vocal cord or other laryngeal issue, and the coughing, that does respond to salbutamol, is more likely to be a manifestation of asthma.

    Rhinitis with post-nasal drip and gastro-oesophageal reflux can also contribute to symptoms like you are describing - and again, these can coexist with asthma and VCD.

    The best person to advise you, and to do further tests if needed, would be an ENT consultant with an interest in rhinitis and/or VCD.

    Personally, I can relate to all the symptoms you are describing, although testing has shown that I'm unlikely to have significant VCD. I attribute most of the apparently 'non-asthma' type symptoms to rhinitis and post-nasal drip, and I also have reflux. I have seen an ENT consultant, who commented that my vocal cords are essentially normal but are quite dry and atrophied (a common side effect of inhaled steroids) which could explain some of the symptoms.

    When I used to see Prof Ayres at Heartlands, he used to say that a degree of laryngeal hyper-responsiveness is very common in asthmatics, particularly brittle asthmatics, even in the absence of overt VCD - or, as he put it 'twitchy airways means a twitchy voice box'. Certainly I have found this to be the case - for example, if I choke on a small amount of liquid - or even sometimes just on my own saliva - I can find that my larynx seems to spasm and I will cough violently, develop a loud inspiratory wheeze and even a sort of stridor sound (the loud, harsh inspiratory noise you get from upper airway obstruction). It looks and sounds very dramatic, as I go bright red trying to suck air in through my spasming larynx, but it's actually not as bad as it looks! It always settles spontaneously within a few minutes, leaving me looking vaguely embarrassed and fighting off well-meaning offers of water, attempts to pat me on the back, and so on!

    If I am getting a more persistent feeling of tightness in my throat (often due to dryness, either a very dry environment or drying of the throat due to drugs or oxygen) I find that saline nebs can be of some use. If you don't have a neb, steam inhalation would probably serve the same purpose.

    Hope this helps

    Em H

  • Thanks EmH, your post was helpful. I am a Rhinitis sufferer too, so a lot of what you mentioned does seem to apply to me - but I don't get reflux. I'm not going to bother finding out more from an ENT specialist, because I don't need anything done about it. Its just helpful to know. The cough you describe which leaves people panicking about your welfare, I can relate to! Often when I'm in a very dry atmosphere, especially if I've got a little bit of a cold, this can really take a hold of me. On occasion I need to rush off for a glass of water and a calm-down, plus some salbutamol for good measure. I hadn't thought of the cough on its own as an asthma symptom, but I obviously do have this at times after all!

    Spaniel xx

  • reflux

    After much to-ing and fro-ing, I too have been diagnosed with reflux. I was very sceptical about this, but my coughing and constant throat clearing was making my throat very sore and making my colleague's life a misery. I have now been diagnosed with something that should work within three weeks or so. I am still an asthmatic so my protocols for that won't change. I have looked up reflux on various websites, and I have to say that the symptoms do all fit. I do not cough at night when asleep and this is apparently because the valve closes when you're horizontal so preventing the reflux from irritating your throat. I look forward to a day without a coughing fit. Watch this space.

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