High Prevalence of Exercise-Induced Laryngeal Obstruction in Athletes
Neilsen EW, Hull JH, Backer V. High prevalence of exercise-induced laryngeal obstruction in athletes. Medicine & Science in Sports & Exercise. 2013;45(11):2030-2035.
Take Home Message: An athlete that reports dyspnea or wheezing is not necessarily suffering from asthma. The differential diagnosis of conditions that present with asthma-like symptoms includes exercise-induced laryngeal obstruction (EILO), which can make finding the true pathology difficult.
Around 70% of athletes report troublesome dyspnea, a condition that is often diagnosed as asthma. However, there are many conditions that present as asthma, one specific example being, exercise-induced laryngeal obstruction (EILO). EILO is a condition characterized by wheezing and dyspnea that is generated by a temporary obstruction at the level of the larynx. The purpose of this retrospective chart review study was to evaluate the prevalence and characteristics of EILO among all of the athletes who were referred for a complete pulmonary functioning assessment during a two year period (88 athletes). The assessment consisted of testing for asthma and the continuous laryngoscopy during exercise (CLE) test, which is used to determine the presence of EILO. The authors found that some athletes tested negative for both asthma and EILO (31 athletes), positive for only EILO (19 athletes), positive for only asthma (26 athletes), and positive for both EILO and asthma (12 athletes). The prevalence of EILO was higher among women than men. Clinical reports of inspiratory wheeze or dyspnea were found in athletes regardless of the presence of EILO. Interestingly, 62% of the athletes in the study with no evidence of asthma or EILO as well as 60% of non-asthmatic athletes with EILO were taking regular asthma medication.
This study points out the importance for healthcare providers to know that not every athlete who wheezes and has decreased pulmonary functioning has asthma. Finding the pathology causing the symptoms should be our priority. Trying to treat the symptoms and prescribing asthma medication may not resolve the underlying issue. A patient who still has exercise-induced respiratory problems despite using asthma medication should be referred for further evaluation for other conditions such as EILO. This study shows that EILO is prevalent alone and in combination with asthma among athletes with asthma-like symptoms. This study opens doors for future studies to look into EILO and hopefully help further educate healthcare providers about the prevalence and importance of diagnosing breathing conditions correctly.
Questions for Discussion: Have you ever had to handle a breathing emergency and if so was your initial diagnosis just as asthma attack? Have you ever heard of EILO? Despite the high prevalence of asthma and conditions with asthma-like symptoms, should there be stricter regulations on the criteria athletes should meet before categorizing them as asthmatics and prescribing medication?
Written by: Chelsea Jacoby
Reviewed by: Lisa Chinn and Jeffrey Driban