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Breathless athlete: exercise-induced laryngeal obstruction
  1. Steffan Arthur Griffin1,
  2. Emil S Walsted2,3,
  3. James H Hull3
  1. 1 Chelsea and Westminster Hospital, London, UK
  2. 2 Respiratory Research Unit, Bispebjerg Hospital, Kobenhavn, Denmark
  3. 3 Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Steffan Arthur Griffin, Chelsea and Westminster Hospital, London SW10 9NH, UK; steffangriffin{at}gmail.com

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Background

Exercise-induced laryngeal obstruction (EILO) describes a condition in which the voice box closes inappropriately during vigorous exercise to precipitate respiratory symptoms, such as cough, wheeze and breathlessness.1 This can occur secondary to adduction of the vocal cords (glottic mechanism)±collapse of the arytenoid or aryepiglottic mucosa (supraglottic mechanism) with complete or incomplete obstruction of the larynx. The condition is highly prevalent in young athletes and estimated to affect between 5% and 10% of all adolescents.2 Despite this, EILO often remains overlooked as the cause of an athlete’s breathing difficulties and is often misdiagnosed as exercise-induced asthma.3 Failure to consider EILO in the differential diagnosis of a breathless athlete can result in delay to the initiation of effective treatment, and also to a potential inappropriate escalation in asthma therapy, with a deleterious impact on health and athletic performance. Research has shown that EILO may coexist with asthma, and distinguishing between these conditions can be challenging and often requires specialist investigation (figure 1). 

Figure 1

Comparing EILO to EIB.  EIB, exercise-induced bronchoconstriction; EILO, exercise-induced laryngeal obstruction.

Case

An 18-year-old female swimmer presents with a 3-year history of breathlessness that develops exclusively during high-intensity exercise. Inhaled asthma therapy, prescribed presumptively for a diagnosis …

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