Vocal-Cord Dysfunction Presenting as Asthma

TLDR

The syndrome may represent a conversion reaction. Five patients with vocal‑cord dysfunction mimicked asthma attacks, were refractory to standard asthma therapy, showed extrathoracic obstruction on flow‑volume curves, had laryngoscopic evidence of vocal‑cord adduction, normal tests when asymptomatic, negative asthma provocation, and improved dramatically with speech therapy and psychotherapy. N Engl J Med 1983; 308:1566–70.

Abstract

We identified five patients with a functional disorder of the vocal cords that mimicked attacks of bronchial asthma. Paroxysms of wheezing and dyspnea were refractory to standard therapy for asthma. During episodes of wheezing, the maximal expiratory and inspiratory flow–volume relationship was consistent with a variable extrathoracic obstruction. Laryngoscopy confirmed that wheezing was due to adduction of the true and false vocal cords throughout the respiratory cycle. During asymptomatic periods the maximal flow–volume relationship and laryngoscopic examination were normal. Provocation tests for bronchial asthma were negative. A variety of personality styles and psychiatric diagnoses were represented; patients were not aware of the vocal-cord dysfunction, which uniformly and dramatically responded to speech therapy and psychotherapy. This syndrome may be a form of conversion reaction. (N Engl J Med 1983; 308:1566–70.)