When a wheeze is not asthma?

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Vocal cord dysfunction (VCD) is an uncommon condition which often mimics asthma in presentation and severity. Vocal cord dysfunction, which is a dysfunction of larynx involves unintentional paradoxical adduction of the vocal cords during inspiration.
It can be evaluated by exercise testing in conjunction with pulmonary function testing in suspected vocal cord dysfunction. In these cases although normal pulmonology function tests are elicited with the patient at rest, exercise testing reveals blunting of the expiratory loop with attenuation of the inspiratory loop unique to VCD. The video laryngoscopy technique confirms the diagnosis.
Exercise testing is a rapid and noninvasive means of diagnosing vocal cord dysfunction in a small subset of patients, but video laryngoscopy, remains the gold standard of diagnosis of VCD.

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