Vocal Cord Dysfunction Laryngeal versus Bronchial Hyper-responsiveness

Bronchoprovocation challenges are often performed to confirm a clinical suspicion of bronchial asthma. Unfortunately despite standardised methodology, the odds of a correct diagnosis applying bronchoprovocation challenge in individuals suspected of asthma, even with the possible addition of markers for bronchial inflammation, remain to be defined. In a consistent number of patients, symptoms are associated neither with bronchoconstriction nor with bronchial hyperresponsiveness (B-HR). One of the reasons may be extrathoracic airway (EA) dysfunction simulating asthma. It is not unusual to find subjects who during bronchial challenge, develop symptoms consistent with vocal cord dysfunction, such as barking cough, dysphonia, chocking and stridorous wheezing. Stridor is the sound created by airflow through a partially obstructed upper airway and occurs mainly during inspiration. It may originate from supraglottic, glottic, or subglottic subsites and it is better correlated with the amount of obstruction than with the site of obstruction