Vocal Cord Dysfunction Mimicking Asthma: A Case Report

Vocal cord dysfunction (VCD) is a respiratory condition characterized by an adduction of the vocal cords, with a resultant airflow limitation at the level of the larynx. The previously reported cases with VCD have been predominantly young women. We herein present an uncommon, elderly case of VCD. This 75-year-old male had been suffering from intermittent inspiratory difficulty and chest discomfort for about 6 years. He had been diagnosed as having asthma for 3 years. Since diagnosis, he has had repeated exacerbations despite aggressive therapy that included corticosteroids, theophylline, and inhaled bronchodilators. However, in the current evaluation, a methacholine inhalational challenge revealed a negative result. The spirometry indicated remarkable flattened inspiratory loops on the flow volume curve while he was experiencing acute symptoms aggravated by an exercise test. Direct visualization, by bronchoscopy, of paradoxical adductive vocal cords movement in the inspiratory phase during a symptomatic period further confirmed the diagnosis. After undergoing maneuvers directed at laryngeal relaxation, and receiving anxiolytic agents from the psychiatrist, he has demonstrated a significantly improved quality of life.