Exercise-induced laryngeal obstruction

The cause of EILO is unclear, but it may be due to laryngeal hypersensitivity. It’s most common in athletic females under 20. Symptoms include shortness of breath, throat discomfort, chest tightness, and wheeze developing during intense exercise.

EILO, for obvious reasons, is typically misdiagnosed as exercise-induced asthma, but does not respond to asthma treatment; if apparent exercise-induced asthma does not seem to respond to treatment, EILO should be considered. Other clues to the diagnosis are:

  • Exercise-induced asthma comes on within minutes of cessation of exercise and resolves within around 30 minutes. EILO comes on during exercise (within seconds of exercise peaking) and resolves more quickly; with a few minutes of rest.
  • In exercise-induced asthma the wheeze and prolonged breathing phase are in the expiratory phase, whereas in EILO they’re in the inspiratory phase.
  • EILO may include symptoms of throat tightness and/or dysphonia, which are not typically found in asthma.
  • Both can be triggered by stress or cold air as well as exercise, but EILO can be triggered by strong odours, and is not triggered by allergies.

Treatment is mainly with physiotherapy and speech/language therapy, using breathing control techniques. Other possibly helpful strategies are laryngeal hygiene (avoid smoking and caffeine; drink plenty of fluid) and inhaled anticholinergics. In severe refractory cases, laser aryepiglottoplasty (surgical debulking of redundant tissue) can be used.

(Br J Gen Pract 2016; 66: 490 – 1)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2016, ENT, Respiratory. Bookmark the permalink.

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