Vocal Cord Dysfunction (VCD), intermittent dyspnoea attacks caused by episodic paradoxical adduction of the vocal cords, plays an important role in the differential diagnosis of so called intractable or difficult to control bronchial asthma. The clinical symptoms may mimic asthma, resulting in high dose medications that often lead to considerable iatrogenic induced morbidity e. g. high dose systemic corticosteriods. In most cases VCD cannot be demonstrated using common diagnostic methods, due to self-limiting symptoms of less than one to two minutes. A typical VCD-patient presents with seemingly life-threatening dyspnoea with negative diagnostic results for asthma or other standard airway disorders and lack of improvement with standard medications. The frustrating clinical course can induce significant psychiatric disorders such as anxiety and panic attacks in VCD-patients. Increased knowledge of the characteristic clinical symptoms of vocal cord dysfunction can help physicians identify the correct diagnosis even without further testing. VCD should be seen as a challenge to every pulmonologists. Early diagnosis prevents prolonged clinical courses including negative effects due to medication as well as economical consequences. The aim of this paper is to present and to discuss the current understandings of the clinical and pathophysiological aspects of this disease.