Vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of VCD is an inappropriate closure of the vocal cords during respiration, according to the National Institutes of Health (NIH). VCD results when the tiny muscles in the voice box, which open and close naturally, remain closed when you’re breathing in. This results in an inability to get air in and out of the lungs effectively. And it often causes panic.
This is not the same as exercise-induced asthma. The condition is familiar to speech-language pathologists but it remains poorly understood in the sports medicine community. Treatment strategies are even less understood.
No sport is clearly better or worse for people with the condition, says Dr. Tod Olin, MD, MCSC, principal investigator of a new study that shows nonsurgical therapy effective for 75 percent of adolescents. Athletes such as runners and swimmers – people who are practicing cardio-specific sports – are more at risk. “Cross-country skiing could even be a trigger.” Dr. Olin is director of the Pediatric Exercise Tolerance Center at National Jewish Health in Denver.
The condition is often misdiagnosed because symptoms overlap with those of asthma. “But about 10 percent of people in the U.S. who assume they have asthma actually have VCD, Dr. Olin says. “[VCD] can happen to anybody and it tends to start at the beginning of puberty.” It’s more common in females, he adds.
VCD, also known as exercise-induced laryngeal obstruction, and asthma are triggered by the type of workout an athlete is performing. VCD shows up with really high-intensity exercises. It is a terrifying shortness of breath and the patient is gasping for air, Dr. Olin says. In comparison, asthma patients complain of coughing at the end of a long run or a swim; they feel throat tightness that is generally not scary, he adds.
VCD can dramatically diminish performance and often causes panic in those who experience it. “We didn’t know why patients were getting better with conventional treatment,” Dr. Olin says, which usually involves speech therapy. Some athletes ultimately quit their sports out of fear or frustration.
The novel approach of treating VCD involves visual biofeedback, training in specific breathing techniques, and feedback regarding performance psychology. “It’s a combination of physical and mental therapy,” Dr. Olin says.
“We thought of putting a camera in the throat of people while they were running fast or riding a bike as fast as they could, which went into the back of their mouth, to better see what was going on, he adds. The camera is fed through the patient’s nose and positioned just above the throat. “We moved the screen so patients can watch what was happening which helps them learn to control their throat’s effect on breathing.
This method also gives a window into the psychology of a person and how he or she reacts when under stress. “We use that to change their thinking,” Dr. Olin adds. During the exercise sessions, he teaches patients breathing techniques to keep the throat open and certain psychological tools so they can conquer their symptoms. One of them is breathing through as if they were blowing candles.
Dr. Olin tested the approach on 41 adolescent athletes with VCD, who had not responded to other interventions. He found that three in four patients perceived improvement in breathing during strenuous exercise; 85 percent called the approach the most important therapy they had undergone to achieve breathing improvement.
Surgery is more common in Scandinavia, Dr. Olin says. “London does more now,” he adds. But it’s invasive and doesn’t have to be first choice. “We’ve been lucky with my approach so far,” he adds. “It’s amazing how the psychology is really impressive, and athletes get it.” The challenge is to teach them to calm down when they’re having a breathing attack, he adds.