Symptom Burden
Vocal cord dysfunction/ inducible laryngeal obstructive symptoms can be disruptive and negatively impact a person’s quality of life (Majellano et al., 2024). During an acute attack, people with ILO/VCD experience various symptoms.
These include:
Breathlessness in ILO/VCD
Breathlessness or shortness of breath is a common, invisible and disabling symptom that can significantly impact an individual’s life. Breathlessness can be an overwhelming and frightening experience, leaving many people with ILO/VCD exhausted and anxious.
Some people with ILO/VCD report that during an acute episode, breathing in feels particularly harder and restricted. They describe this breathlessness sensation as distinctly different from the breathlessness experienced with asthma. The sensation is often compared to trying to walk through a closed door and stop, where there is no way to drag air in. No matter how hard they try, everything feels out of control.
When talking, people with ILO/VCD report that they can only manage to speak in short sentences before needing to pause. Attempting to talk for longer periods would cause their shortness of breath to worsen. Additionally, the tightness in their throat, coupled with croakiness, frequently leaves them breathless.
You’d only have very short sentences and then stop pause and then continue from there. Talking a bit longer makes… me more so breathless
ILO/VCD Triggers
To help the patient better control their symptoms, discuss with them the advantages of avoiding or minimising their triggers. Individual triggers should be the main emphasis of education. Triggers can be related to environmental exposures, strong smells or irritants, psychological symptoms, or exercise. Common triggers include:
Environmental
Smoke exposure (including cigarette and bushfire), weather conditions, dust and pollen may trigger symptoms of ILO/VCD.
Strong smells/irritants
Avoiding exposure to harmful chemicals or irritants reduces ILO/VCD symptoms.
Occupational/exercise
Occupational
Symptoms of ILO/VCD can be triggered by an occupational or professional voice demand. It is important to determine how the function or activity performance is related to ILO/VCD symptoms.
Exercise-induced ILO/VCD
Exercise can bring symptoms of ILO/VCD. Exercise-induced ILO/VCD is frequently misinterpreted as asthma. When patients with exercise-induced asthma are diagnosed with dyspnoea on exertion, it is important to take this into consideration, especially if they do not respond well to standard bronchodilator treatment.
A multidisciplinary approach is required for managing exercise-induced ILO/VCD. The team is often made up of otolaryngologists, respiratory specialists, speech pathologists, and psychologists. Referral to speech pathology for respiratory retraining therapy is considered first-line treatment for exercise-induced ILO/VCD
Psychological
Emotional stress, depression and anxiety are triggers, a tailored psychotherapy or speech therapy is a recognised treatment strategy and can improve ILO/VCD symptoms.
Effects of ILO/VCD on physical and emotional health
While everyday living tasks (home duties) are not immediately affected, people with VCD/ILO often feel too tired to carry on their basic communication needs and are easily exhausted when talking.
ILO/VCD may also interfere with personal relationships. Due to their unreliable voice, some people found it challenging to converse clearly with their partners particularly whose partners have hearing impairments. Misunderstandings and confusions can result, making it difficult for both individuals to understand and communicate properly.
The lack of control of a sudden voice loss or change and even poor voice projection can make it difficult for someone to communicate effectively. The inability to communicate effectively can make them feel socially disconnected and inadequate. Sometimes a person with ILO/VCD may tend to avoid or speak briefly to others.
The lack of control in being able to communicate and express themselves freely makes anyone with ILO/VCD feeling frustrated, embarrassed, annoyed, anxious, annoyed, depressed and worried. At times, people with VCD condition can be unfairly judged being sick. Misjudgment can stem from ‘hoarse’ or ‘croaky’ voice and leaving others feeling compelled to explain the cause of their condition.
The effects of ILO/VCD can impact someone’s identity. A sense of identity loss can develop when their voice fails them, typically related to their ability to perform at work or conduct their much loved hobbies or avocations.
Impact of ILO/VCD on financial health
ILO/VCD can also impact a person’s career and ability to work effectively leading to potential income loss or reduce work productivity. Some people had to switch jobs or needing frequent time off from work.
“I would have quite some time off from work as a result of that (VCD symptoms) and probably at my last school before I retired the [boss] was questioning why I was having so much time off“
A lack of awareness or knowledge of ILO/VCD is a significant barrier to effective treatment. ILO/VCD awareness is important for early assessment, diagnosis, and effective treatment. From the patient perspective, as symptoms of ILO/VCD mimic asthma, patients can be confused as to whether asthma were causing their breathlessness. Engaging patients in their care is important to increase disease awareness and improve health outcomes.