Variable extrathoracic obstruction?

[medic1985]

Went to the allergist the other day for baseline PFTs since I have a Hx of asthma (even though I am on no meds for it and it hasn't bothered me in years and only when I was sick with a URI).  Saw him last week for skin testing because my nasal allergies were pretty bad and I hadn't been tested in like 20 years.  Anyways, my PFT's showed that my inspiratory loop was pretty much completely flat.  This was after three tries, and then again three tries after a proventil treatment (I guess just in case it was atypical asthma presentation?) Everything else was normal (don't have the numbers with me).  He thinks it might be vocal cord dysfunction,..

I am 33 years old, slightly overweight, female, smoker (9 pack years--and I was planning my quit date for Monday before these PFTS!).  I also have a Hx of pretty bad GERD, but it has been controlled w 40mg of nexium a day (no heartburn, but occasional reflux), IBS for which I take levsinex and fiber (which has been not so good lately).  The allergist just started me on Veramyst and I've been taking claritin OTC as well.

I did mention to him that over the past few months, I've had a few cases of hoarseness and cracking of my voice--very mild, only lasting a short time, and no fever, sore throat or anything indicating an infection....in fact, I had developed a bit of cracking in my voice the previous night, and all I was doing was watching tv (no shortness of breath), still had it a tiny little bit that morning went I had the PFTs done.  I'm not a professional singer or anything, but any time I hear music, I'm always singing....

He wants me to come back in 3 months and repeat the PFTs.  Does this sound appropriate?  Should I wait and see if the allergy meds work?  Or should I notify my gastroenterolgist as well, see if maybe it's attributed to my GERD?  Could it be something else, like polyps?  Just wondering and any information would be greatly appreciated.....Thank you in advance for your help!

[National Jewish Health]

The repetitive flat inspiratory loops do indeed suggest the diagnosis of vocal cord dysfunction (VCD).  Attempts should be made to confirm the diagnosis with fiberoptic laryngoscopy while you are having symptoms.  If this is normal then a methacholine challenge along with laryngoscopy may determine if the problem is VCD or asthma even at a time when you are not having symptoms.

There is no good reason to wait 3 months.  You should consult with your gastroenterologist, as there is a definite relationship between VCD and gastroesophageal reflux disease (GERD).  There is also the problem of silent reflux, in establishing cause and effect.

[medic1985]

Don't know if this makes a difference, but I figured I'd also mention I had a tonsillectomy/adnoidectomy in October of 2007 for repeated infections (6x a year for the last 2 years).