Gasp, cough, shortness of breath… sore throat, tight chest… and no relief?

Have you been diagnosed with asthma, but an inhaler doesn't help your symptoms? You may actually have a problem with your vocal folds, also known as vocal cords. A misdiagnosis can be frustrating–and even scary, especially when you feel like you can’t breathe!

Sometimes, people diagnosed with asthma are actually struggling with a condition called vocal cord dysfunction, or paradoxical vocal fold dysfunction (PVFD). This is a condition that impacts the vocal folds, and its symptoms are quite similar to asthma. Treatment, however, is different, and it often includes voice therapy with a speech-language pathologist. So a correct diagnosis is key to being able to breathe easier.

What is vocal cord dysfunction, or paradoxical vocal fold dysfunction (PVFD?)

Paradoxical vocal fold dysfunction (PVFD), also sometimes called vocal cord dysfunction (VCD) or paradoxical vocal fold movement (PVFM), is when the vocal cords close together when you take a breath in. This leads to difficulty getting enough air in your lungs.

Your vocal folds play an important role in your body. They vibrate to produce sound when you speak. (Try making a “zzzz” sound with your hand on your throat–you’ll feel your vocal folds “buzzing”!) They’re designed to come together when you cough and clear your throat, in order to protect the airway from irritants, such as chemicals, smoke, or fumes. The vocal folds also come together during swallowing, to protect the airway from food or liquid.

When you take a breath in, however, your vocal folds should open up to allow air to enter the airway and pass through to the lungs. With PVFD, the vocal folds tighten, or close, during inhalation, which leads to difficulty breathing.

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How are asthma and PVFD similar and different?


Often misdiagnosed as asthma, PVFD can cause similar symptoms of wheezing, coughing, stridor (a harsh, vibrating noise when breathing), and other breathing difficulties.

Some of the similarities between asthma and PVFD include the following:

  • Both lead to wheezing, chest tightness, and difficulty breathing
  • Symptoms can range from mild to severe
  • Both lead to narrowing of the airway
  • Both can be managed by avoiding triggers that are likely to cause an attack
  • Both conditions significantly impact the individual’s quality of life, cause feelings of distress, and can lead to fainting episodes

The following chart highlights the main differences between asthma and paradoxical vocal fold dysfunction:

Asthma 

PVFD 

Impacts the lungs 

Constriction is at the level of the vocal folds 

Is usually controlled with medications and/or inhalers 

Is usually controlled by working with a trained speech pathologist specializing in the area of upper airway disorders 

Those with asthma usually report difficulty with breathing out (exhaling) 

Those with PVFD usually report difficulty getting air in (inhaling) 

What causes PVFD, and what are some common triggers?

Your vocal cords produce the sounds of your voice, which is critical for communication. However, their primary function is to protect your airway to help you breathe and swallow! If your vocal folds come together during inhalation, instead of opening, your brain is recognizing “dangers,” or triggers to the voice box. Your throat responds to these triggers by coughing, throat clearing, or closing the airway, and your vocal cords respond by closing and blocking your ability to breathe freely. People with PVFD often have very sensitive airways.

Although there is no known cause of PVFD, there are several triggers that can lead to a more sensitive and reactive airway, including, but not limited to:

  • Acid reflux, or laryngopharyngeal reflux
  • Allergens
  • Stress, anxiety, and/or trauma
  • Exercise
  • Chemicals, smoke, and fumes
  • Temperature changes
  • Overusing your voice, or high vocal demand  

Who diagnoses PVFD?

It’s understandable that asthma and PVFD often get confused in the diagnosis process. However, a treatment is only as good as an accurate diagnosis, so it’s important to find the right clinician to evaluate your symptoms.

If you’ve been diagnosed with asthma but your medication isn’t helping, or you simply have concerns about breathing problems, it may be worth visiting an otolaryngologist to determine if your vocal folds are causing your symptoms. An otolaryngologist is also known as an ear, nose, and throat doctor. Even if you don’t experience a breathing attack during your appointment, the doctor will be able to rule out any underlying conditions. If the otolaryngologist diagnoses PVFD, they will develop a treatment plan for you. This will likely involve a referral to a speech-language pathologist who specializes in the area of voice and upper airway disorders.

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What does speech therapy, or voice therapy, look like for PVFD?

Voice therapy will focus on breath retraining and identifying triggers that may be contributing to your breathing attacks. Your speech therapist will teach you techniques and exercises to calm and manage symptoms when you have a breathing problem. Therapy is holistic; it also helps retrain the brain’s response to triggers by calming the nervous system with exercises such as mindful breathing and grounding.

Paradoxical vocal fold dysfunction can be incredibly scary for the person experiencing it. An accurate diagnosis and treatment plan helps reduce the discomfort and fear associated with becoming short of breath, so you can breathe more easily.