The Heterogeneity of Exercise Induced Laryngeal Obstruction (EILO)

“

Writing this short communication was done for Three reasons: 1) raising the awareness of exercise induced laryngeal obstruction (EILO) so that confusions with other medical problems becomes less likely in the future; 2) advocating for the utility of continuous laryngoscopy during exercise to properly diagnose EILO; 3) raising awareness of the multiple therapeutic modalities that we have for EILO. ABSTRACT Exercise Induced Laryngeal Obstruction (EILO) is common and symptoms are often misinterpreted as asthma. There is no evidence-based approach to treatment. We present two athletes perceived and treated as “difficult-to-treat” asthma. On admission, both reported compromised physical performance due to breathing difficulties; careful questioning revealed these to be primarily inspiratory, peaking at peak exercise and abating as ventilatory requirements normalized. Baseline spirometry, salbutamol reversibility and methacholine provocation did not support asthma. Methods: Continuous laryngoscopy during maximal cardiorespiratory treadmill exercise (CLE) was used to visualize laryngeal movements from rest to peak intensity. First-line therapy for EILO at our institution is thorough physician-guided review of the videorecordings, structured breathing advice and reassurance. Second-line options are speech therapy or physician-guided inspiratory muscle training (IMT), with supraglottoplasty reserved for highly selected supraglottic cases. Findings: Both patients had EILO with supraglottic obstruction preceding glottic obstruction, becoming more pronounced with increasing respiratory demands. As evident from accompanying videos and legends, their clinical course and treatment differed. Conclusion: Significant exercise related breathing problems require objective test methods. EILO should be diagnosed endoscopically during ongoing exercise. Treatment should be individualized with effects monitored clinically, utilizing CLE-testing in non-responders and if surgery is contemplated.

”