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Asthma

Maybe it`s not all asthma

07/24/2008

Question:

Hello, I`ve been on and off steroids, mostly on since 2000. It`s been giving to me for asthma and sinus related issues. I haven`t been responding too well to inhalers. I kept telling my doctor(s) I feel the wheezing in my throat first many times then it gets worse and I have to start the predinisone after I see the nebulizer isn`t doing the job. So, now they have me on Xolair and after almost 6 months there is little improvement. I think someting is going on in my throat. Now, they think perhaps it`s not all due to Asthma since I`m not getting relief as I should. It could perhaps be some condition in my throat. Can you tell me what conditions might cause my problems in my throat that trigger asthma symptons beside Gerd. I`m so distressed by all the side effects of the steroids and desparately want someone to find a solution as I know there is one....just no one has found it or is capable.

Answer:

The most common condition of the throat that mimics asthma is vocal cord dysfunction. In this condition, inflammation of the vocal cords and the tissue around the vocal cords leads to abnormal partial closure of the vocal cords during breathing. This is often associated with episodes of severe coughing or hoarseness and a wheeze that is heard or felt in the throat. This condition does not necessarily respond to inhalers or Xolair, and sometimes dry powder inhalers can make it worse by further irritating the vocal cords. Oral corticosteroids can make it better by reducing inflammation. Gastroesophageal reflux laryngitis can exacerbate this condition. This condition can fluctuate in severity much like asthma.

Vocal cord dysfunction can be easily diagnosed by videolaryngoscopy, in which a small scope is used to examine the larynx and film the response of the vocal cord during breathing and talking. Many otolaryngology departments have the facilities to perform videolaryngoscopy. Other less common lesions of the upper airway, such as fixed obstructions can also be detected by this method.

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Response by:

Charity C Fox, MD Charity C Fox, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University