Many young athletes are diagnosed with exercise-induced asthma but may, in fact, have vocal cord dysfunction. The problem? It is often difficult to differentiate between the two.
There are multiple irritants in the air that can trigger breathing problems in young athletes: pollen and airborne irritants, chlorine in pools, and nitrogen oxides, which are used on resurfacing ice rinks.
Symptoms of vocal cord dysfunction are similar to those of exercise- induced asthma, with shortness of breath, chest tightness and cough. However, the cough of vocal cord dysfunction tends to have a seal-like barking quality, and the athlete may complain of throat tightness and changes in the pitch of their voice. This is not present in exercise-induced asthma. Color changes of the skin may also be noted in vocal cord dysfunction–paleness or redness. In asthma, blue or purplish discoloration (cyanosis) can be present.
Vocal cord dysfunction has an abrupt onset and resolution of symptoms, whereas exercise-induced asthma requires 5-10 minutes of exercise and persists for 30-60 minutes without treatment. Pulmonary function testing (to show how well the lungs are working) will be normal in vocal cord dysfunction patients, while in exercise-induced asthma athletes the testing will typically reveal underlying asthma.
Treatment for vocal cord dysfunction is based on education of the patient, family and coaches; speech therapy, antihistamines and use of long-lasting acid-inhibiting medications (proton pump inhibiters) as needed. Relaxation therapy and breathing exercises also generally help reduce symptoms.
Exercise-induced asthma is treated with short-acting bronchodilator inhalation therapy (aerosol inhalers) such as Proventil/ Proair / Ventolin. Daily use can reduce the effectiveness of the medications and side effects may include tremors and fast heart rate.
If a young athlete is having breathing issues when participating in sporting practices or competitions, they should be evaluated by a medical professional to determine between the possibility of exercise-induced asthma or vocal cord dysfunction.