[Vocal cord dysfunction or bronchial asthma?].

Vocal cord dysfunction (VCD) is a functional laryngeal dysfunction first described in the nineteenth century. It is quite frequent in patients with "refractory" asthma. It is very often treated as a steroid resistant asthma or exercise-induced bronchospasm, leading to unnecessary, aggressive asthma treatment and iatrogenic morbidity. Vocal cord dysfunction causes paradoxical adduction of vocal cords during the inspiratory phase of respiratory cycle, resulting in acute, episodic dyspnea not responding to typical antiasthmatic treatment. Laryngoscopy remains a gold standard for the diagnosis of vocal cord dysfunction. Additional pulmonary function tests may be useful. Fast and appropriate diagnosis of VCD is only possible with close collaboration of laryngologists and asthma specialists. The treatment of dyspnea attack in VCD involves psychological counseling, heliox application and sedative/anxiolytic agents. Long term treatment may include speech therapy, biofeedback, yoga and autohypnosis.