High Prevalence of
Exercise-Induced Laryngeal Obstruction in Athletes

EW, Hull JH, Backer V. High prevalence of exercise-induced laryngeal
obstruction in athletes. Medicine & Science in Sports & Exercise.

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.

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.

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
Reviewed by: Lisa Chinn and Jeffrey Driban

Related Posts:

Nielsen EW, Hull JH, & Backer V (2013). High prevalence of exercise-induced laryngeal obstruction in athletes. Medicine and Science in Sports and Exercise, 45 (11), 2030-5 PMID: 23657163