Patient presents with symptoms consistent with vocal cord dysfunction (VCD), also known as paradoxical vocal fold motion (PVFM) and laryngeal dyskinesia.  Symptoms include episodic shortness of breath, dyspnea, tightness in the throat, stridor, wheezing, and cough.  These episodes can mimic asthma exacerbations but do not respond to typical asthma therapies like bronchodilators.  Onset of symptoms is often sudden and can be triggered by exercise, irritants, stress, or gastroesophageal reflux disease (GERD).  Physical examination during an episode may reveal paradoxical adduction of the vocal cords during inspiration, observed via laryngoscopy.  Differential diagnosis includes asthma, allergic reaction, anaphylaxis, and upper airway obstruction.  Pulmonary function tests (PFTs) may show a flattened inspiratory loop, supporting the VCD diagnosis.  Patient education regarding the nature of VCD and its distinction from asthma is crucial.  Initial management includes breathing exercises, such as respiratory retraining and diaphragmatic breathing techniques.  Referral to a speech-language pathologist experienced in VCD management is recommended for voice therapy and laryngeal control exercises.  Consideration for psychological evaluation and treatment for anxiety or stress management may be indicated if contributing factors are identified.  Patient instructed on symptom triggers and avoidance strategies.  Follow-up scheduled to assess symptom control and response to therapy.  ICD-10 code J38.5 (paralysis of vocal cords and larynx, other) and relevant CPT codes for laryngoscopy and therapeutic interventions will be documented for billing purposes.