Vocal Cord Dysfunction in Patients with Predominant Upper Airway Symptoms

Vocal cord dysfunction (VCD), a functional disorder characterized by abnormal and involuntary adduction of the vocal folds, can mimic asthma or other respiratory disorders. We analyzed a subset of VCD patients that presented with predominantly upper airway symptoms and were misdiagnosed as anaphylaxis. We conducted a retrospective analysis of 132 subjects with VCD seen at an outpatient university allergy clinic. VCD diagnosis was confirmed with flexible laryngoscopy. We compared the demographics, comorbidities, clinical symptoms and medication use of VCD subjects with predominantly upper airway symptoms mimicking anaphylaxis versus those with predominantly lower airway symptoms mimicking asthma or other respiratory disorders. Twelve subjects (9.1%) had symptoms that mimicked those of upper airway obstruction. There was no difference in age (p=0.3) or gender (p=0.7) between the two groups. VCD subjects with upper airway symptoms were more likely to have a past medical history of food allergy (p=0.003), chronic urticaria/angioedema (p=0.009), and psychiatric illnesses (p=0.005), but were less likely to have a history of pulmonary disease (p=0.002). The patients with upper airway symptoms were also more likely to experience dysphonia (p=0.002), stress and anxiety (p=0.002), and be prescribed epinephrine (p<0.0001) or psychiatric medications (p=0.04). VCD mimicking anaphylaxis has a lower prevalence than VCD mimicking asthma in a university allergy clinic. VCD patients misdiagnosed with anaphylaxis have distinguishing symptoms, comorbidities, and medication use compared to VCD patients misdiagnosed with asthma or other pulmonary disorders. Recognizing this unique population can lead to timely diagnosis and prevent mistreatment with unnecessary medications and procedures.