Methods: An 11-year-old boy with a history of moderate asthma, chronic sinusitis and allergic rhinitis presented to our office for immunotherapy. Months later, he developed paroxystic coughing episodes after which he collapsed from fatigue. Episodes occurred several times during daytime without obvious triggers. There was no respiratory distress, hemoptysis, fever or vomiting. He had already been seen by two pediatric pulmonologists who treated him with steroids for his asthma.
Results: Our pulmonary function tests showed variable extrathoracic obstruction, and laryngoscopy confirmed the diagnosis of VCD. He was started on Tessalon perles, and referred to speech therapy and a psychologist as part of a long-term prevention strategy. Coughing spells have since improved.
Conclusions: Patients with VCD are often diagnosed with asthma and treated with beta-adrenergic agents and inhaled corticosteroids with little improvement. Coughing will cause a brief adduction of the vocal cords followed by abduction when forceful exhalation is produced. Panting can also be beneficial by activating the posterior cricoarytenoid muscle and causing vocal cords abduction. By having purposeful coughing spells, our patient was trying to relieve the discomfort of the adducted vocal cords by forcing them to abduct. This case illustrates that VCD can be a missed diagnosis, which potentially can prolong treatment in patients with pre-existing allergy and asthma.