Abstract
The report and description of the issue of factitious disorder (formerly known as Munchausen’s syndrome) was interesting and informative.1 The patient described presented with features of acute severe asthma but this diagnosis was discounted when more information became available. Another mimic of acute severe asthma deserves mention in this context – a condition commonly known as vocal cord dysfunction (VCD) but perhaps more accurately termed paradoxical vocal fold motion (PVFM)2 and historically termed Munchausen’s stridor.3 It is characterised by episodic unintentional paradoxical adduction of the vocal cords (or other laryngeal structures), resulting in upper airway obstruction. Patients may experience a variety of symptoms including dyspnoea, cough, stridor, wheezing, neck tightness and voice changes. These symptoms are often precipitated by physical activity and intense emotion. Presentation may be dramatic and can be mistaken for acute asthma, anaphylaxis or angioedema.