Long-term outcome of vocal cord dysfunction.
BACKGROUND
Vocal cord dysfunction (VCD) is an involuntary functional disorder commonly misdiagnosed as asthma. Previous reports describe the disorder and treatment but not the long-term outcome.


OBJECTIVE
To determine the long-term outcome of VCD.


METHODS
A retrospective medical record review identified 49 patients, ages 8 to 25 years, diagnosed as having VCD from 1989 to 2002. Telephone contact was attempted in all.


RESULTS
Of the 49 patients, 41 had previously been treated for asthma; that diagnosis was confirmed by us as a comorbidity in only 12 patients. Two distinct phenotypes of VCD were observed. Symptoms were limited to exercise-induced VCD (EIVCD) in 29 and spontaneously occurring VCD (SVCD) in 20, only 4 of whom additionally had EIVCD. Twenty-eight of the 49 were successfully contacted by telephone. Eight of the 11 contacted patients with SVCD followed the recommendation to see our speech therapist, all of whom learned to control symptoms. However, 2 who also had EIVCD continued with that problem. Pretreatment with an anticholinergic inhaler prevented EIVCD in 6 patients in whom this was tried. Complete absence of symptoms, at times ranging from 1 week to 5 years (median, 5 months), was reported in 26 of the 28 contacted patients.


CONCLUSIONS
VCD continues to be frequently misdiagnosed as asthma. Two phenotypes of VCD are apparent: EIVCD and SVCD. Speech therapy provides relief of symptoms for SVCD. Prevention of EIVCD with an anticholinergic inhaler in 6 patients suggests that a controlled clinical trial is warranted. Regardless of treatment, eventual spontaneous resolution was common.
Doshi
Devang R
DR
Pediatric Allergy and Pulmonary Division, University of Iowa College of Medicine, Iowa City, Iowa, USA.
Weinberger
Miles M
MM
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D015897:Comorbidity; D015444:Exercise; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D013070:Speech Therapy; D016896:Treatment Outcome; D014827:Vocal Cords; D014832:Voice Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy
D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D009241:Ipratropium