IBCC Episode 85 - Vocal Cord Dysfunction

Vocal cord dysfunction (VCD) presents as a diagnostic challenge that frequently mimics asthma, leading to inappropriate intubations and a cycle of mislabeling. Unlike asthma, which involves small airway obstruction, VCD is an upper airway phenomenon characterized by audible stridor and a lack of respiratory distress upon mechanical ventilation. Clinical diagnosis relies on identifying the pattern of rapid-onset shortness of breath and utilizing bedside maneuvers, such as asking the patient to sing or pant, which can temporarily override the dysfunctional neurological circuit. While nasal laryngoscopy remains the gold standard for visualization, CT imaging of the neck and chest effectively rules out life-threatening anatomical obstructions like epiglottitis or tracheal stenosis. Management prioritizes patient education and breathing techniques, with ketamine serving as a potential diagnostic "litmus test" to differentiate functional VCD from fixed anatomical airway obstruction in acute settings.