Identification of Vocal Cord Dysfunction by Methacholine Laryngoscopy Reduces Inhaled Corticosteroid and Rescue Inhaler Use in Children and Adults

Vocal cord dysfunction (VCD) is associated with chest tightness, shortness of breath and wheezing, often masquerading as asthma. The gold standard for diagnosis of VCD is direct laryngoscopic visualization during a symptomatic episode. Methacholine (MCT) is a nonspecific irritant, when used in conjunction with laryngoscopy, can trigger episodes of VCD and evaluate for concomitant asthma. While VCD can co-exist with asthma VCD alone can mimic asthma and result in unnecessary pharmacologic therapies. 103 patients (female, n=67) who underwent MCT laryngoscopy from 09/2008 - 01/2011 were retrospectively identified using ICD-9 codes. A database was developed to track relevant data, including demographics (eg, sex, age), laryngoscopic findings, and response to medications. The average patient age was 23 years; the majority were under age 20 (n=67), 69% (n=71) were white non-Hispanic and 19% (n=20) were black non-Hispanic. Prior to MCT challenge and laryngoscopy, 66% (n=68) of patients were prescribed daily inhaled corticosteroid therapy with/without long acting beta agonist. 78% (n=80) of patients noted symptoms (dyspnea, wheeze, throat tightness etc.) following MCT challenge, but only 55% (n=56) had a significant (>/=20%) drop in their FEV1. 70 patients (68%) had VCD visualized on direct laryngoscopy. After diagnosis of VCD, 53% (n=37) were noted or recommended to have a decrease in use of daily corticosteroids and 51% (n=36) reported a decrease in rescue beta-2 agonist use. Identification of VCD can be made in allergy clinic using MCT challenge combined with direct laryngoscopy. Diagnosis of VCD leads to decreased daily inhaled corticosteroid and rescue inhaler use.