Paradoxical Vocal Fold Dysfunction- searching for relief

[songcat]

In the past year, I was diagnosed w/Paradoxical Vocal Fold Dysfunction (PVFD) - after inhaled steroids and prednisone dose pack failed to help lingering bronchitis. Also was visualized w/laryngoscope.I have had asthma/allergies my entire life (I'm almost 35 now); the ENT doc put me on Prevacid 30mg 2x/day and had me supplementing up to 4 weeks at a time w/Zantac 150mg at bedtime, reasoning that acid reflux was the main culprit of my breathing difficulties.  Endoscopy revealed a small patch of Barrett's esophagus(lower), but nothing else (no ulcers, esophageal erosions, etc.)& pH study confirmed "reflux," while esophageal mannometry revealed a non-specific "motility problem."The Prevacid did get rid of chest pain from reflux, but not my breathing problems.  My pulmonologist says it's "multi-factorial." I also have problems w/ cardiac dysrhythmias which also cause shortness of breath. An electrophysiologist has stated that these are "benign."  The G.I. doc says to get a Nissen fundoplication (I'm a newlywed and hope to have a child in the next 1 1/2 to 2 1/2 years.) I even went to several speech therapy sessions for diaphragmatic&rhythmic breathing.  Is it possible to have a reactive airway i.e SOB, due to Prevacid? I do not take anything else - I even stopped birth control pills, thinking that might be a culprit.  I never know quite what to do when breathing is difficult because I don't know if it's "asthma"(then bronchodilator works), or the "PVFD" (then nothing seems to work!) Apparently reflux treatment is not curbing the PVFD, so, is there anything else to help me?

[National Jewish]

You mentioned that the Prevacid® (lansoprazole) got rid of your chest pain, but maybe it is not completely controlling your gastroesophageal reflux disease (GERD).  GERD is the back flow of stomach contents, including digestive juices, into the esophagus or food tube.  This is most commonly called acid reflux or heartburn.  This acid reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  This could explain your symptoms.  Surgery such as the Nissan fundoplication that your gastroenterologist has suggested is generally done only if medicines are not controlling your symptoms.  Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information.

Vocal cord dysfunction (VCD) is a condition that can mimic asthma.  However, VCD is not helped by asthma medicines.  While inhaling the vocal cords should open to let air into the lungs.  With VCD the vocal cords close together during inhalation.  This makes it difficult for air to get into the lungs.  Upper respiratory infections, fumes, odors, cigarette smoke, singing, emotional upset, postnasal drip and exercise may trigger VCD.  Sometimes the trigger is not known.  Testing needs to be done while you are having symptoms.  A laryngoscopy like you had done is one way of testing for VCD.  Using a camera at the end of a flexible tube your doctor is able to see how your vocal cords open and close.  Another way of testing is a breathing test called spirometry that includes an inspiratory flow volume loop.  The “breathing in” or inspiratory part of a breathing test will show little airflow while you are inhaling.  VCD is treated by a speech therapist that will instruct you in open throat breathing techniques.  Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD.  Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information.

It is possible to have VCD with or without asthma.  If you have both, it is important that you learn to tell whether it is the VCD or the asthma causing the attack.  Only then will you be able to use the treatment that will help stop the attack.  Asthma medicines do not help VCD.  The open throat breathing technique does not help asthma.

Since your shortness of breath is continuing you might consider a second opinion from a pulmonologist at a university medical center in your area.  This would include a physical examination and possibly spirometry, laryngoscopy, and a chest x-ray.  The most important thing is to find out what is causing your shortness of breath so that the problem is effectively treated.  This should be done prior to any surgery.

[Concerned lady]

If you could be seen at Nat'l Jewish Medical & Research Center, in Denver, Colorado, you could get expert medical help, so that you could recognize when you're having an asthma &/or a VCD attack.

You can speak with a LUNG LINE nurse, by calling 1-800-222-LUNG(5864), to see about possibly scheduling a visit to Nat'l Jewish.

If you can't go to Nat'l Jewish, or, for local medical follow up after going to Nat'l Jewish, ask a LUNG LINE nurse about which docs may be in your area, who studied at Nat'l Jewish, and are VCD-knowledgable.

My husband and I each had VCD, several years ago, and we each were finally correctly diagnosed at Nat'l Jewish. We don't have any VCD attacks any more. If you'd like to compare notes, you can email me at ***@****

I wish you the best!

Concerned lady
<a href=http://cantbreathesuspectvcd.com>http://cantbreathesuspectvcd.com</a>