Vocal cord dysfunction related to water-damaged buildings

Abstract

Background: Vocal cord dysfunction (VCD) is the intermittent paradoxical adduction of the vocal cords during respiration, resulting in variable upper airway obstruction. Exposure to damp indoor environments is associated with adverse respiratory health outcomes, including asthma, but its role in the development of VCD is not well described.

Objective: We describe the spectrum of respiratory illness in occupants of 2 water-damaged office buildings.

Methods: The National Institute for Occupational Safety and Health conducted a health hazard evaluation that included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the 2 buildings, employees, and consulting physicians. In addition, medical records and reports of building evaluations were reviewed. Diagnostic evaluations for VCD had been conducted at the Asthma and Allergy Center of the Medical College of Wisconsin.

Results: Two cases of VCD were temporally related to occupancy of water-damaged buildings. The patients experienced cough, chest tightness, dyspnea, wheezing, and hoarseness when in the buildings. Spirometry was normal. Methacholine challenge did not show bronchial hyperreactivity but did elicit symptoms of VCD and inspiratory flow-volume loop truncation. Direct laryngoscopy revealed vocal cord adduction during inspiration. Coworkers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations provided evidence of water damage and mold growth.

Conclusion: VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms.

Keywords: Asthma; Dampness; FEV(1); FVC; FVL; Flow-volume loop; Forced expiratory volume in 1 second; Forced vital capacity; Mold; NIOSH; National Institute for Occupational Safety and Health; VCD; Vocal cord dysfunction.