Vocal cord dysfunction in patients presenting with asthma exacerbation

Asthma is a common disease affecting 5-7% of the population in USA. Vocal cord dysfunction (VCD), a condition where abnormal adduction can occur, may mimic or coexist with asthma. In a select group of difficult to treat asthmatics referred to a tertiary care center, VCD alone was found in 9%, while 35% had both VCD and asthma (Neuman, et al). However, the exact incidence of VCD in patients presenting with asthma exacerbation is not known. Therefore, we elected to evaluate the incidence of VCD in those presenting to the emergency center (EC) with asthma exacerbation by laryngoscopy. Methods: Fifteen patients admitted to the EC for asthma exacerbation were recruited. After topical anesthesia, direct laryngoscopy was done with topical anesthesia. Results: PFTs Laryngoscopy Diagnosis No. Normal Normal Normal 1 Reversible Normal Asthma 8 obstruction Abnormal VCD 2 Reversible Abnormal Asthma 4 Obstruction & VCD Conclusions: 1) In this study involving small number of patients, 2 had VCD only while 4/15 had both asthma and VCD. Majority had asthma exacerbation alone; 2) High index of symptoms for VCD should be entertained in acute asthma exacerbation and confirmed by direct laryngoscopy done where indicated, and 3) The optimal evaluation of patients with symptoms of asthma exacerbation and normal FEV₁ should include upper airway evaluation.