Home from hospital with dual diagnosis - asthma & VCD

Evening, I'm still quite new to this forum thing although always been an asthma sufferer. I've just come home after a week in hospital where I was treated for a severe asthma exacerbation. However, I have also been diagnosed with something called VCD, Vocal Chord Dysfunction. This is on top of my asthma diagnosis and I just wondered if anyone else had any info on it. My asthma is not brilliant at present and VCD can mimic symptoms, but Consultant has told me this is a dual diagnosis. Having a bit of trouble getting my head round it all. Any info/advice gratefully received!

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  • Normally when you inhale and exhale a gap opens up between the vocal cords so that air can move from the lungs to the mouth. In some people, the chords do the opposite from time to time: instead of opening up they try to close, making it hard to breathe.

    There are a lot of theories about why this happens. One theory is that in people who have both VCD and asthma, the VCD was originally part of a breathing adaption to make an asthma attack less bad, but backfired and became maladaptive. Another theory sees it as a maladptive form of the grunt reflex - for example, when one pushes hard if constipated or lifting heavy objects or pulling on a rowing machine, sometimes the throat closes up. This might explain why some atheletes have VCD.

    There are also people who think VCD is sometimes purely psychological. They'll point to annecdotal stories like a teenager who seems to get a VCD attack whenever she has a fight with her family. But personally, I think it might be more complicated than ""psychological"". Strong feelings change the way we use our voices and vocal cords. Think for a minute about how some peoples voices change timber and resonance when they are particularly angry or happy or impatient, and maybe you see what I mean. The physical things our bodies do to create those changes may also in turn trigger whatever makes the vocal cords start misbehaving and so trigger VCD.

    I imagine your cons has discussed the possible treatments? It depends on why they think the cords are acting up, but usually the first line treatment is speech therapy so that you can gain some conscious control over what your vocal cords are doing and don't have to be their victim.

    Best of luck.

  • Yes, we've had a long discussion. Seeing physio, ENT & SALT. Done a pile of reading since I've seen Cons and aware that some people see it as a 'psychological'. I don't think so!! Been in hospital for a week with very scary asthma exacerbation, this was definitely asthma as responded to meds. Glad to be home.

  • Hi Magic Dragon :)

    Firstly, glad you're home and hopefully feeling a bit better.

    Secondly, SNAP! I am a life long asthmatic whose asthma got worse about 4 years ago and became brittle nearly two years ago.

    My diagnosis (from RBH) is severe brittle asthma with supra added VCD (on top of and making the asthma worse basically).

    I have just been discharged from SALT and found it really good and im now able to recognise the difference between the asthma element and the vcd element, im able to control the vcd and can now stop vcd from becoming severe.

    I've seen physios, chest physios and ENT too (as well as resp cons) and have found the joint approach really beneficial as each one works on a slightly different bit or focus and all together it seems to have worked great so I hope it does for you too.

    The whole psychological thing is very old school thinking and for me had no relevance. My vcd was caused by my larynx 'learning' the behaviour of my trachea due to my asthma being very out of control as muscle has 'memory'.

    Do go to SALT etc with an open mind, some of the exercises are weird and wonderful, you will be shown loads but will probably find a few that work well for you.

    Feel free to ask any questions, I felt very lost when I got the vcd diagnosis as there isn't much known about it.

    xxx

  • Hi Angelica,

    Thank you so much for the post. You diagnosis seems very like mine! Asthma still not great but VCD not helping at all. I had never heard of it before and neither had the staff on the ward including the medical consultant!! Very open minded about treatment, happy to do whatever it takes. It's good to hear that you can recognise the difference, did that take you long? Admission was very scary this time and due to the asthma not the VCD!! I do feel a little lost to be honest, it's good to know it's not just me though!

    Grateful for your support.

  • I want to echo what Angelica said about being able to tell the difference, although my perspective might be a little different. It really is possible to develop a good sense of which part of your body is involved in an airflow problem.

    I don't have VCD (it was considered but ENT ruled it out), but I do have a couple of related experiences. First, when I started to study voice I used to have a big problem with using my throat to support my voice. At first it was hard for me to tell what muscles and parts of body were involved in singing, but over time and with lots of practice I really did learn. Although that training came from singing rather than speech therapy, there is some overlap. What I learned from study and practice has been really helpful in dealing with asthma as well.

    Sometimes when I'm having a very hard time breathing, I lose a certain amount of coordination in swallowing and also the vocal cords. For instance, I had a nasty flare about a year ago where everytime I breathed in I was making a horrible sound (stridor/inspiratory wheeze). Because of my voice training, I was able to tell right off that I was having a problem with coordinating my vocal cords and because of my training, I also had techniques to consciously chose to relax them. Relaxing my vocal cords didn't make the asthma attack go away, of course, but it was one less problem I had to deal with on my way to urgent care.

    This summer I had a really really bad cough - part infection and part asthma. It so irritated my larynx that it started to spasm whenever something hit it wrong. My ENT told me that I could stop the laryngospasm by sticking my head in the fridge (really! - he's the master of low tech solutions). There was one problem: cold air aggravates my asthma, so it was important to know whether I was coughing and having trouble breathing because of my asthma or my larynx. Howver, at the end of the day, it didn't turn out to be a problem because I knew my body well enough to be able to tell what part was initially triggering the cough. So I was able to take advantage of his advice without trigger asthma.

    As for the psychological: if you don't think it fits you, then it probably doesn't. IMHO there is WAY too much blaming asthma on psychology. My point only in raising it was that even when something looks like it is psychogenic , there is often a physiological explanation that shows it is really just normal emotions (its normal for the voice and use of the vocal cords to change when we're emotional) combined with some kind of more or less physiological problem that over-reacts to those changes.

    Best of luck, beth

  • Cheers Beth, all info gratefully received. Head spinning with info, both with regard to asthma and VCD. Problem at the moment is that asthma is totally pants!! Ah well, I guess we'll get there.

  • Hi and sorry for the delay in answering, I don't come on here very often.

    It sounds like you have the perfect 'can do' attitude which will help massively im sure :)

    My resp cons didn't have a clue either but we both did research and decided SLAT was the way to go as neither of us felt there was a psychological factor involved for me.

    It took me about 5 sessions of SALT which was over about 3 months so not super quick but not too long either.

    I found that getting the VCD under control and the improvement in my breathing technique (it had become 'dysfunctional' due to all the attacks) has had a big impact on my asthma in general and I am having fewer attacks/bronchospasm etc.

    I will say I was also on lots of meds including some very hard core immune suppressants to it all helped together.

    Take care and persevere xxx

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