Vocal Chord Dysfunction
Difficult to DiagnosePublished October 29, 2001 in The Post-Standard.
By Dr Kamal Jabbour, Contributing Writer
Just when I thought I had heard of all known running injuries, I encountered Vocal Cord Dysfunction with my daughter, Paula. Commonly mistaken for exercise induced asthma, VCD strikes athletes of all ages. During or following a race or intense workout, VCD can manifest itself through heavy dry coughing, difficulty breathing, throat closure, wheezing and a chocking sensation.
When Paula started coughing four months ago, x-rays showed a sinus infection. Two weeks of antibiotics cleared her sinuses, but the cough persisted. Repeated visits to the doctors brought about a variety of diagnoses. Cough medicine had a limited benefit. Allergy medication proved ineffective. The summer passed by, and Paula continued coughing, especially during her runs.
Cross country season added a new dimension, as coughing developed into chocking, wheezing episodes. She finished most races down on her hands and knees, gasping for several minutes. More visits to the doctors shifted the diagnosis towards exercise-induced asthma. The causality of intense exercise to the attacks added credence to the diagnosis.
Inhaler in hand, Paula conquered the trails but not the cough. The limited effectiveness of the inhaler in the midst of wheezing attacks suggested operator error. Paula received medical training on using an inhaler, and the parade of drugs continued without effect. Eventually, her doctor ordered a pulmonary function test, which Paula passed with flying colors. Years of running resulted in lung capacity in excess of normal.
After four months of coughing and a series of ineffective treatments, a lung specialist suggested VCD as the culprit. A quick read of the literature matched the symptoms to the diagnosis. Unfortunately, the earlier misdiagnoses and treatments were counter-indicated, and exacerbated her condition.
In hindsight, Paula's initial sinus infection and the accompanying postnasal drip had irritated her vocal cords. The cough medicine and decongestant dried up her cords and irritated them further. The allergy and asthma medications were ineffective, and the chemicals in the inhaler triggered coughing.
In turn, running and racing caused heavy breathing, forcing air through the trachea at high speeds, drying up the injured cords and sending them into spasms. Coughing resulted, further irritating the cords, and forcing the body to close the throat to protect them. The attacks became more frequent as the cross country season progressed and the fall air turned colder, adding insult to the injured cords.
The diagnosis of VCD brought about an immediate cessation of all medication and a premature end to the cross country season. Within days, the wheezing attacks ended, and the occasional coughing mostly occurred in predictable environments. With further tests on the calendar and an anticipated recovery of a few months, Paula seeks to give her injured cords time to heal from both running and cheering.
Information about VCD is available on the web at http://www.cantbreathesuspectvcd.com.
Kamal Jabbour runs and writes on the hills of Pompey, New York. His RUNNING Column appears in The Post-Standard on Mondays. Dr.J. created TrackMeets.com, webcasting live Every Lap of Every Race. He receives email at firstname.lastname@example.org.
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