A novel trigger of vocal cord dysfunction

Published Online: December 3, 2012

The vocal cords are open (abducted) during normal breathing. Vocal cord dysfunction (VCD) describes a condition in which the vocal cords close (adduct) during breathing. This abnormal movement of the vocal cords results in intermittent obstruction of the upper airway. Symptoms of VCD include episodes of shortness of breath, cough, noisy breathing (stridor or wheeze), throat or chest tightness, and hoarseness. Although the symptoms may mimic asthma, they are typically unresponsive to asthma medications and instead may respond to relaxation. VCD has previously been described following exposure to a variety of respiratory irritants. Exposure to damp indoor environments is associated with respiratory problems including asthma, but its role in the development of VCD is not well described.

A study recently published in The Journal of Allergy and Clinical Immunology: In Practice by Dr. Kristin J. Cummings and colleagues investigates the relationship between exposure to water-damaged buildings and VCD. The authors describe the evaluation of two office buildings where occupants reported respiratory problems. The evaluation included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the two buildings, employees, and consulting physicians. In addition, the authors reviewed workers’ medical records and reports of building evaluations.

Two building occupants experienced cough, chest tightness, shortness of breath, wheezing, and hoarseness when in the buildings. Clinical evaluation included laryngoscopy, which demonstrated abnormal closure (adduction) of the vocal cords during breathing in both cases. They were diagnosed with VCD. Co-workers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations documented water damage and mold growth. The building occupants with VCD continued to have symptoms in the buildings despite remediation efforts. They ultimately left employment due to VCD.

VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms. The primary therapy for VCD occurring in relation to a water-damaged building should be exposure cessation. These cases highlight the diagnostic and therapeutic challenges that exposure-related VCD can pose.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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