Some Kids Are Being Misdiagnosed With Asthma, Study Finds

Vocal cord dysfunction (VCD) is the sudden, abnormal narrowing of the vocal cords during inhalation causing obstruction of the airflow, and is characterized by a noise that can mimic the sound of wheezing. A VCD attack can easily be mistaken for an asthma attack though it does not respond to asthma medications.

Treatment of VCD relies on correct identification of the disorder using breathing and relaxation techniques to help the vocal cords relax. During an acute VCD attack, spirometry (a device that measures airflows) can show patterns that are highly suggestive of VCD.

Doctors at Columbus Children's Hospital performed a clinical research study using spirometry in Children's Emergency Department to try to identify adolescents who had findings suggestive of VCD compared to an acute asthma attack. The year-long study (February 2005-February 2006) included patients 12-21-years-old who suffered from acute episodes of respiratory distress.

"Both asthma and VCD are very common, and emergency departments across the country are seeing more and more kids with these kinds of symptoms," said Karen McCoy, MD, chief of Pulmonology at Columbus Children's Hospital and a faculty member at The Ohio State University College of Medicine. "While they may appear similar to parents, the conditions act differently and must be treated differently. It is important that parents, coaches and family doctors are aware of the differences."

According to the study, 12 of the 17 adolescents who presented to the Emergency Department with difficulty breathing, but with high normal oxygen levels, were found to have evidence of VCD on spirometry. This led to a change in the therapy for these patients. Spirometry used in the acute setting of difficulty breathing can help differentiate VCD from asthma attacks.

"Our study suggests that if more emergency departments made use of the spirometry test, it could cut down on the number of kids who are misdiagnosed and potentially hospitalized," said Muffy Chrysler BS, RRT, NPS, AE, a co-author on the study and an asthma coordinator in Respiratory Care at Columbus Children's Hospital.

The research was published in the July issue of Pediatric Pulmonology.

Paul Nolan, MD, FAAP, the study's lead author, was a fellow at Columbus Children's Hospital while working on this manuscript. Nolan, a pediatric pulmonologist, is now with Texas Tech University Health Sciences Center and is a faculty member in the Department of Pediatrics at Texas Tech.