Dear Dr. K: With the massive damage still being shown on TV from the flooding by Hurricane Sandy, what illnesses are those residents facing? A timely study recently released by the medical College of Wisconsin recently reported on a study of patients developing Vocal Cord Dysfunction (VCD), a mimic of asthma, due to environmental exposure in water-damaged work environments. Water-damaged environments have long been recognized as a cause for a variety of respiratory illnesses, including infections, rhinitis, sinusitis and asthma. This is due to the indoor dampness and the attendant mold growth, both of which impact the respiratory system. Until now, VCD had not been described in this setting.
VCD is the inappropriate approximation of the vocal cords during inhalation. That is, the vocal cords move together while breathing in, instead of moving apart the way they are supposed to behave. This results in inspiratory wheezing, coughing, hoarseness and chest tightness. Asthma, on the other hand is an expiratory illness – that is, the wheezing and restriction of air movement is primarily during exhalation, not inhalation. This is an important distinction because the various inhalers and medications that benefit asthmatics don’t help people with VCD.
Other recognized causes for VCD include extrinsic irritants, cleaning solutions, machine fluids, cooling fumes, dust, smoke, eucalyptus, the fixative glutaraldehyde, xerographic toner and other chemicals and scents. It can also occur for psychogenic and neurogenic reasons. It is important to recognize VCD as the correct diagnosis, since the primary effective therapy is avoidance of the provoking environment. Speech therapy directed at improving laryngeal control has additional benefit.