eMedicine Specialties > Allergy and Immunology > Asthma

Vocal Cord Dysfunction: Follow-up

Author: Praveen Buddiga, MD,, Physician, Allergy, Asthma and Immunology, Baz Allergy, Asthma and Sinus Center, Fresno, California
Contributor Information and Disclosures

Updated: Jul 10, 2009

Follow-up

Further Outpatient Care

  • Patients must receive further care to determine the response to patient education and speech therapy and to assess the need for referral for psychiatric care.
  • Many patients with vocal cord dysfunction (VCD) are treated inappropriately with corticosteroids if they present to an emergency department or acute care facility even after the diagnosis of VCD is established. A handout for the patient to show to new physicians may be helpful to avoid inappropriate treatment.

    Vocal cord dysfunction treatment plan.

    Vocal cord dysfunction treatment plan.

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    Vocal cord dysfunction treatment plan.

    Vocal cord dysfunction treatment plan.

Deterrence/Prevention

  • Deterrence and prevention can be achieved by adherence to speech therapy guidelines and exercises and by relaxation therapy or other measures to decrease anxiety.

Prognosis

  • Prognosis is good with effective response to speech therapy, which allows patients to take control of their disorder.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize coexisting asthma or to recall that vocal cord dysfunction (VCD) is a diagnosis of exclusion
  • Failure to recognize functional causes of upper airway obstruction (eg, other pulmonary, cardiac, and structural laryngeal abnormalities) that must be excluded because they may be the etiology of the patient's respiratory symptoms
  • Failure to recognize the following organic causes or associated problems, which must be excluded:
    • Brain stem compression
    • Upper and/or lower motor neuron injury
    • Gastroesophageal reflux
    • Asthma
    • Foreign body obstruction
    • Anaphylaxis or other cause of laryngeal edema

Special Concerns

  • Early diagnosis of VCD prevents adverse effects of unnecessary and ineffective antiasthmatic therapy (especially corticosteroids).
  • Larger population trials are needed to further delineate the true incidence of VCD that is mistaken for asthma because the data in the authors' review indicate that VCD is more common than previously perceived.
 


More on Vocal Cord Dysfunction

Overview: Vocal Cord Dysfunction
Differential Diagnoses & Workup: Vocal Cord Dysfunction
Treatment & Medication: Vocal Cord Dysfunction
Follow-up: Vocal Cord Dysfunction
Multimedia: Vocal Cord Dysfunction
References
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Further Reading

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Keywords

vocal cord dysfunction, VCD, paradoxical vocal cord motion, laryngeal dyskinesia, abnormal adduction of the vocal cords during the respiratory cycle, airflow obstruction, variable extrathoracic obstruction, inspiratory loop flattening, depression, obsessive-compulsive disorder, borderline personality disorder, neuroses induced by childhood sexual abuse, asthma

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Contributor Information and Disclosures

Author

Praveen Buddiga, MD,, Physician, Allergy, Asthma and Immunology, Baz Allergy, Asthma and Sinus Center, Fresno, California
Praveen Buddiga, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, and American Medical Association
Disclosure: Glaxo Smith Kline  Honoraria Speaking and teaching

Medical Editor

Stephen Rosenfeld, MD, Professor Emeritus, Department of Medicine, Allergy, Immunology and Rheumatology Unit, University of Rochester School of Medicine and Dentistry
Stephen Rosenfeld, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American Federation for Clinical Research, Clinical Immunology Society, and Medical Society of the State of New York
Disclosure: Elan Ownership interest None; Invitrogen Ownership interest None; Merck Ownership interest None; Pfizer Ownership interest None; Medco Health Ownership interest None; Millipore Ownership interest None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael R Simon, MD, MA, Clinical Professor Emeritus, Departments of Internal Medicine and Pediatrics, Wayne State University School of Medicine; Adjunct Staff, Division of Allergy and Immunology, Department of Internal Medicine, William Beaumont Hospital
Michael R Simon, MD, MA is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Federation for Medical Research, Michigan Allergy and Asthma Society, Michigan State Medical Society, Royal College of Physicians and Surgeons of Canada, and Society for Experimental Biology and Medicine
Disclosure: Secretory IgA, Inc. Ownership interest Board membership

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD, Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians
Disclosure: Abbott Consulting fee Consulting; Alcon Consulting fee Consulting; Glaxo Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering Consulting fee Consulting; Teva  Consulting; Meda Honoraria Speaking and teaching

 
 
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