It’s very exciting with the Olympics just a few weeks away to watch these incredible athletes, who have devoted their lives to this moment, get a chance to perform their exercise genius. I also find it interesting to hear the different stories from these Olympians and the challenges they have had to overcome to reach their goals. One of the most difficult challenges for any Olympian has to be a medical condition that interferes with their endurance. A breathing disorder, like asthma, is an incredible challenge physically and mentally to any athlete.
With asthma, the lungs constrict and the person feels like they are breathing through a tiny straw. Now, picture an Olympic athlete either running at full speed or swimming and experiencing this condition. Interestingly, Olympians have to be specially screened who are taking asthma medications to get an exemption from the anti-doping rules set up by the Olympics so that an athlete doesn’t get a special advantage by taking these medications.
Some studies have shown that an athlete, when given a diagnosis of exercise-induced asthma, didn’t actually have asthma in 3 to 15% of the cases. In these cases, the diagnosis of vocal cord dysfunction was the actual cause of the difficulty breathing. You may ask, ” What’s the difference, does it matter?”. The answer is a resounding, “Yes!”. Patients with vocal cord dysfunction typically don’t respond well to bronchodilator inhalers, such as Proventil, Ventolin or albuterol- even in a nebulizer. The reason is that the problem isn’t in the bronchioles of the lung, but the vocal cords are moving in a “paradoxical motion”- that is in the opposite direction of how they should be opening when you are breathing in. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution(Marlowe 2006) I devote a whole chapter to conditions that mimic asthma.
The diagnosis of vocal cord dysfunction can be very tricky. You need to observe a person in a breathing attack to do the proper testing. One test that can help make a diagnosis is a Pulmonary Function test that looks at the Flow-Volume loop on inspiration. This part of the loop will appear ” flattened” instead of the normal pattern of a semicircle. Ask your doctor to pay special attention to this component of the breathing test and show you himself. The other test, which is considered the “Gold-Standard” to diagnose vocal cord dysfunction is a laryngoscopy, where the physician looks at the vocal cord movements.
The symptoms of vocal cord dysfunction can mimic asthma but there are warning signs that can point your physician to make the correct diagnosis:
- Shortness of Breath, especially in the throat, but also in the chest
- Chest pain
- No wheezing on expiration (Breathing out)
- Your asthma medications don’t give relief within 5 to 10 minutes
For some unknown reason, young women are more prone to this condition than men. One theory is women are reaching puberty with fluctuating hormones, and especially ones that are found in stressful situations or high achievers.
The treatment of vocal cord dysfunction is very different than asthma: no medications are necessary. The key treatment is special breathing techniques that stretch the diaphragm and prevent the vocal cords from adducting (coming together) when they should be abducting (opening apart). A good speech pathologist can help a patient develop this proper breathing technique.
So, whether you are headed to London as an athlete, or just to your local gym to get exercise if your “asthma” has not been well-controlled, ask your doctor to work with you to re-evaluate your diagnosis.
Go Team U.S.A!!!