Services · Upper airway disorders
When you can't breathe and nobody knows why
Upper airway disorders (ILO, PVFM, and VCD) are frequently misdiagnosed as asthma. Speech therapy is the first-line treatment.
Inducible Laryngeal Obstruction (ILO), Paradoxical Vocal Fold Motion (PVFM), and Vocal Cord Dysfunction (VCD) cause sudden breathing episodes that feel like suffocation. If your inhaler isn't working, it may not be asthma.
Clinical overview
Understanding upper airway disorders
Your throat closes. You can't get air in. It feels like you're suffocating. And your inhaler does nothing.
Inducible Laryngeal Obstruction (ILO), Paradoxical Vocal Fold Motion (PVFM), and Vocal Cord Dysfunction (VCD) are conditions where the vocal folds inappropriately narrow or close during breathing, particularly on the in-breath. This creates sudden episodes of breathing difficulty, throat tightness, noisy breathing (stridor), and a choking sensation. These episodes are frightening. Many patients describe them as the most terrifying moments of their lives.
Upper airway disorders are frequently misdiagnosed as asthma because the symptoms look similar: shortness of breath, wheezing, respiratory distress. But asthma medications target the lower airways. ILO, PVFM, and VCD affect the upper airway at the level of the larynx. Inhalers won't fix what's happening at the vocal folds. Many patients spend years on escalating asthma medications that provide little relief, because the diagnosis is wrong.
Differential diagnosis
ILO/PVFM/VCD vs Asthma: Understanding the Difference
Why Misdiagnosis Happens
Upper airway disorders and asthma share similar symptoms: shortness of breath, wheezing, and respiratory distress. But they affect different parts of the airway and need different treatments. Many patients cycle through multiple asthma medications with limited success before discovering the breathing difficulty originates from the vocal folds, not the lungs. This delay often spans years.
Features Suggesting ILO/PVFM/VCD
Upper-airway origin
- · Inspiratory stridor (noisy breathing in)
- · Throat tightness or choking sensation
- · Triggered by odours, exercise, or stress
- · Voice changes during episodes
- · Poor response to asthma inhalers
Typical Asthma Features
Lower-airway origin
- · Expiratory wheeze (noisy breathing out)
- · Chest tightness rather than throat
- · Allergies, pollen, or weather triggers
- · Normal voice quality
- · Good response to asthma medication
Important Note: Co-existence
Some patients have both an upper airway disorder AND asthma at the same time. This makes diagnosis harder and treatment more confusing. We work directly with your respiratory physicians and ENT specialists to ensure both conditions are managed properly. Treating one while ignoring the other leaves you stuck.
What you'll gain
Speech therapy outcomes
Know what to do mid-episode
Rescue breathing techniques you can use immediately, before panic takes over. You'll practise them until they're automatic.
Finally get the right diagnosis
Years of inhalers and no improvement? We evaluate breathing patterns, identify upper airway involvement, and coordinate ENT laryngoscopy confirmation.
Return to exercise without fear
Sport-specific breathing protocols: graduated exposure, warm-up routines, and in-the-moment techniques. Goal is full training return.
Your respiratory team, connected
Detailed reports to your GP, respiratory physician, and ENT. We attend multidisciplinary meetings when needed.
Manage triggers before they escalate
Stress, strong smells, cold air, reflux. Once you know your triggers, we build strategies around each one. Prevention beats crisis management.
Reduce episodes over time
With consistent practice, most patients move from frequent, terrifying episodes to rare, manageable ones. Some achieve complete resolution.
First-line treatment
Speech therapy: the first-line treatment
Speech therapy is internationally recognised as the first-line treatment for ILO, PVFM, and VCD. Not a supplementary add-on. Not a last resort. First line.
The reason is straightforward: these conditions involve the vocal folds behaving abnormally during breathing. Medications can't retrain that behaviour. Inhalers target the wrong part of the airway entirely. What works is teaching the laryngeal muscles to respond differently, and that's what speech therapists do.
We start with rescue breathing techniques so you have something to use immediately when an episode hits. From there, we build a programme around your specific triggers: diaphragmatic breathing for respiratory control, progressive laryngeal tension reduction, exercise protocols if sport is involved, and anxiety management if stress plays a role.
Most patients see real improvement within 2-6 sessions. You'll practise techniques in clinic, then daily at home.
Folded-in · #chronic-cough anchor
Chronic refractory cough
A cough that lasts more than eight weeks and is often dry and irritable. We require respiratory work-up to rule out other causes of respiratory dysfunction.
Chronic cough management often includes a very thorough case history and description about the coughing pattern. Followed by education and strategies to suppress a cough and manage hypersensitivity. Supplementary tools including chronic cough diaries can be used. Breathing techniques can be used to encourage relaxed open-throat breathing and nasal route breathing to calm irritability.
When chronic cough persists despite normal medical results, the problem usually sits in laryngeal hypersensitivity or habitual patterns. Both respond to the techniques we use in clinic.
Patient scenarios
Who we help
Misdiagnosed for years
You've been told it's asthma. Preventer inhalers, reliever inhalers, nebulisers, oral steroids: nothing works properly. Your GP keeps escalating medications. You've ended up in A&E during bad episodes and been sent home with “asthma management plans” that don't manage anything. Nobody has questioned whether it's actually asthma.
Episodes during sport
You're an athlete. Or you were, before the breathing episodes started. Running, swimming, cycling, team sport. Exertion triggers something terrifying. Your throat slams shut. You can't get air in. The inhalers don't touch it. You want to train again. You need someone who understands what's actually happening.
→ #chronic-cough adjacent
Stress shuts your throat
It happens in meetings. Presentations. Difficult conversations. Conflict. Your throat tightens, breathing becomes noisy, and you feel like you're choking in front of colleagues. You've been told it's anxiety, and maybe anxiety plays a role, but this is a physical event, not a panic attack. The distinction matters, because the treatment is different.
→ #chronic-cough
The cough that won't clear
Eight weeks. Twelve. Six months. Every test. Every medication. The scans are clear, but the cough is still there, and worse when you talk, laugh, or eat. Your respiratory work-up came back normal. Speech therapy targets the laryngeal hypersensitivity that medicine can't reach.
Asthma AND upper airway disorder
The most confusing scenario. You have confirmed, medication-responsive asthma, but some of your episodes don't respond to treatment. Your respiratory physician suspects an upper airway component on top of the asthma. We address the laryngeal piece while your medical team manages the asthma piece. We coordinate both sides.
Pricing
Clear pricing, no surprises
In-person · Wellington clinic
Initial assessment
$320
Follow-up sessions
from $240
Telehealth · nationwide
Initial assessment
$260
Follow-up sessions
from $200
Frequently asked
Questions about upper airway therapy
Do I need a referral? +
To effectively work with upper airway conditions we do require a respiratory or ear, nose and throat assessment prior. This rules out other causes and confirms the upper airway involvement before therapy begins.
How is upper airway disorder diagnosed? +
Laryngoscopy by an ENT specialist during symptom provocation is the gold standard. The specialist watches the vocal folds in real time and can see them closing when they should be opening. Pulmonary function tests may show inspiratory flow limitation as a secondary indicator. We work closely with ENT and respiratory physicians to get you an accurate diagnosis, not another round of asthma medications.
How long does treatment take? +
Most patients see real improvement within 2-6 sessions over 4-8 weeks. You'll learn rescue breathing techniques in the first session, something you can use immediately. Athletes and exercise-triggered cases may need additional sessions for sport-specific protocols. Some patients achieve complete resolution. Others develop strong management skills that make episodes rare and short-lived.
Can I continue my asthma medication? +
Yes. If you have confirmed asthma alongside your upper airway disorder, keep taking your prescribed asthma medications. Speech therapy addresses the laryngeal component, the part your inhalers can't reach. We coordinate with your respiratory physician so both conditions are managed together, not separately.
Is telehealth effective for upper airway disorder therapy? +
Yes. We can observe your breathing patterns, demonstrate techniques, and give real-time feedback via video. Many athletes and professionals prefer telehealth because it fits around training and work schedules without travel time. The techniques translate directly. You're practising in the environment where episodes actually happen.
Is upper airway disorder misdiagnosed as anxiety? +
Anxiety can trigger upper airway episodes, and episodes can trigger anxiety. They feed each other. But the laryngeal closure is a physical event. Your vocal folds are literally closing during breathing. Telling someone to 'just relax' doesn't address the mechanism. We teach specific techniques that interrupt the closure pattern. If anxiety management is also needed, we coordinate with psychologists.
How much does upper airway therapy cost? +
Initial assessment: $207 in-person at our Wellington clinic, $167 via telehealth. Follow-up sessions: in-person $157, telehealth $127. Most patients need 2 to 6 sessions. We provide invoices for insurance claims.
Start with a free conversation
Ready to breathe easier?
Free 15-minute telehealth conversation to talk through what's happening and whether speech therapy is the right next step.