Asthma Complexities

  • Medical Author:
    George Schiffman, MD, FCCP

    Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideAsthma Symptoms, Causes, and Medications

Asthma Symptoms, Causes, and Medications

Vocal cord dysfunction (VCD)

Vocal cord dysfunction is an episodic condition involving sudden closure of the voice box (larynx) as a result of the two vocal cords sticking together. This can be physiologic, that is the vocal cords are not working properly due to dysfunctional nerves or structural abnormality. This condition usually requires involvement of ENT physician and often will not correct itself spontaneously.

It can also be caused by paradoxical vocal cord movement, factitious asthma, spastic dysphonia, and globus hystericus. The symptoms of vocal-cord dysfunction are the sudden onset of difficulty breathing and talking, and panic. This can result in a high pitched inspiratory sound, referred to as stridor. Vocal cord dysfunction often is misdiagnosed and treated as asthma because both conditions may have symptoms of wheezing; however, with vocal-cord dysfunction, wheezing usually occurs during inspiration (breathing in), while with asthma, wheezing occurs during expiration (breathing out). Medications used for treating asthma are not effective for treating vocal-cord dysfunction.

Since a correct diagnosis of vocal-cord dysfunction can be difficult, affected people may have repeated episodes that are inappropriately treated as attacks of asthma. The diagnosis often requires a careful, direct inspection of the vocal cords, typically by an ear, nose, and throat specialist. The attacks of vocal-cord dysfunction when psychological usually resolve spontaneously (on their own). Sometimes these cases can present quite dramatically, and raise concerns about potential respiratory arrest. Occasionally , a tracheotomy tube is inserted because of concerns of a true physiologic abnormality. Vocal-cord dysfunction often is associated with acute panic or anxiety attacks that require antianxiety medications, speech therapy, and psychotherapy in order to prevent episodes.

Other hypersensitivity (allergic) reactions

Inhaled mold spores and particles from bird droppings and feathers (such as from parrots) can cause hypersensitivity (allergic) reactions in the bronchial tubes and the lungs. For example, when Aspergillus fungal spores cause an allergic reaction in the bronchial tubes, the condition is called allergic bronchopulmonary aspergillosis. Affected individuals have both asthma and bronchiectasis which require treatment with both bronchodilators and corticosteroids over a prolonged period of time. Sometimes antifungal therapy is used, as well. When the lung tissues develop an allergic reaction to inhaled bacteria, fungi, or bird particles, the condition is called hypersensitivity pneumonitis (HP). HP is differentiated from acute asthma by the lack of wheezing, the presence of a fever, and the pattern of pneumonia on the chest X-ray. HP is treated by avoiding the allergens and administering corticosteroids.

Medically Reviewed by a Doctor on 7/20/2017

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