lignocaine can also been used in acute cases and helium-oxygen inhalation given by face mask has been used in cases of respiratory distress. psychological approaches psychological interventions including psychotherapy, cognitive behavioural therapy (cbt), biofeedback, and teaching self-hypnosis are also suggested to treat vcd. intervention is generally targeted at making the client aware of stressors that may trigger vcd symptoms, to implement strategies to reduce stress and anxiety, and to teach techniques for coping with their symptoms. cbt can focus on bringing awareness to negative thought patterns and help reframe them by focusing on problem solving strategies. psychologists may also use relaxation to reduce distress when a patient is experiencing symptoms. biofeedback can be a helpful addition to psychotherapy. the aim of biofeedback is to educate the client on what happens to the vocal cords during breathing and to help them learn to control their symptoms. choosing an intervention strategy needs to be assessed by a multidisciplinary team and individualized therapy planned carefully, keeping the characteristics of each patient in mind. prognosis the natural prognosis of vcd in both children and adults is not well described in the literature. additionally, there is currently no research that has studied whether the underlying cause of vcd makes a difference in the resolution of symptoms or in the long-term prognosis of the impairment. information on the prognosis of vcd after acute therapies is also limited. minimal response has been documented with the continued treatment of asthma in people with vcd using inhaled bronchodilators, corticosteroids and other asthma medications. while using botox in vcd has limited reports, those that are available report successful resolution of exercise-induced vcd symptoms for up to 2 months. outcomes of chronic vcd treatment are similarly limited. when pediatric patients undergoing hypnosis therapy were studied, more than half saw either a reduction or resolution of vcd. even though it is widely used, no long-term studies have been done to study the prognosis of vcd after psychotherapy. speech therapy is the main course of treatment for long-term management of vcd and includes a variety of techniques such as relaxed-throat breathing, respiratory retraining therapy, and vocal hygiene counselling. most studies agree that symptoms of vcd improve in patients and few continue to require asthma medications six months post speech therapy intervention. significant improvements were reported for respiratory retraining therapy, including fewer episodes of dyspnea per month and decreased respiratory stress severity. for those adolescent patients who recovered from vcd, the average time before the symptoms were resolved was 4–5 months. however, some adolescents had vcd symptoms even 5 years post vcd onset, regardless of intervention. it has been noted that some patients do not respond to standard vcd therapies and continue to express recurrent symptoms. epidemiology there is currently a limited amount of information available on the incidence and prevalence of vcd, and the various rates reported in the literature are most likely an underestimate. although vcd is thought to be rare overall, its prevalence among the population at large is not known. however, numerous studies have been conducted on its incidence and prevalence among patients presenting with asthma and exertional dyspnea. a vcd incidence rate of 2% has been reported among patients whose primary complaint was either asthma or dyspnea; the same incidence rate has also been reported among patients with acute asthma exacerbation. meanwhile, much higher vcd incidence rates have also been reported in asthmatic populations, ranging from 14% in children with refractory asthma to 40% in adults with the same complaint. it has also been reported that the vcd incidence rate is as high as 27% in non-asthmatic teenagers and young adults. data on the prevalence of vcd is also limited. an overall prevalence of 2.5% has been reported in patients presenting with asthma. among adults with asthma considered "difficult to control", 10% were found to have vcd while 30% were found to have both vcd and asthma. among children with severe asthma, a vcd prevalence rate of 14% has been reported. however, higher rates have also been reported; among one group of schoolchildren thought to have exercise-induced asthma, it was found that 26.9% actually had vcd and not asthma. among intercollegiate athletes with exercise-induced asthma, the vcd rate has been estimated at 3%. in patients presenting with symptoms of dyspnea, prevalence rates ranging from 2.8% to 22% have been reported in various studies. it has been reported that two to three times more females than males have vcd. vcd is especially common in females who have psychological conditions. there is an increased risk associated with being young and female. among patients with vcd, 71% are over the age of 18. in addition, 73% of those with vcd have a previous psychiatric diagnosis. vcd has also been reported in newborns with gastroesophageal reflux disorder (gerd).