Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction

Abstract

IntroductionExercise-induced bronchoconstriction (EIB) is a common condition in endurance athletes. Exercise-induced vocal cord dysfunction (EIVCD) is a frequent confounder of EIB. The diagnosis of EIVCD may be challenging and can be missed as the problem is often intermittent and may only occur during intense exercise. Eucapnic voluntary hyperventilation (EVH) is the best test to detect EIB. This pilot study aimed to assess if EVH could be helpful in the diagnosis of EIVCD associated or not to EIB in athletes.MethodsA nasolaryngoscopy was performed during a 6 min EVH test, in 13 female athletes suspected to have VCD, aged 21±7 years. Image analysis was conducted by two Ear Nose and Throat surgeons in random order.ResultsDuring the EVH, three athletes showed incomplete paradoxical vocal cords movement, without inspiratory stridor. However, 12 athletes showed marked supraglottic movement without inspiratory stridor. In two athletes, this supraglottic movement was severe, one showing a marked collapse of the epiglottis with an almost complete obstruction of the larynx by the arytenoid cartilage mucosa. In 3 of the 12 athletes with supraglottic movement, severe vibration of the mucosa covering the arytenoid cartilages was also observed.ConclusionsEVH challenge in athletes can provide information on various types of glottic and supraglottic obstruction in reproducing laryngeal movements during hyperventilation. Our findings make us suggest that exercise induced upper airway obstructions should be named: Exercise-induced laryngeal obstruction (EILO). Then, EILO should be divided in three categories: supraglottic, glottic (EIVCD) and mixed (glottic and supraglottic) obstruction.

Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on ‘acute respiratory illness in the athlete’

“…In a retrospective chart review of university athletes presenting with exertional respiratory complaints, postexertional laryngoscopy (among other tests) identified EILO in 70% of athletes, and 37% had coexisting asthma 30. In a cross-sectional study of 352 athletes who underwent EVH challenge during flexible laryngoscopy, 41 (12%) were suspected of having EILO 31. EILO was verified in all 41 athletes, using a surrogate challenge that did not reproduce respiratory distress 31.…”

“…In a cross-sectional study of 352 athletes who underwent EVH challenge during flexible laryngoscopy, 41 (12%) were suspected of having EILO 31. EILO was verified in all 41 athletes, using a surrogate challenge that did not reproduce respiratory distress 31. In 37 healthy rowers without respiratory complaints, EIB was diagnosed in 27% and EILO was diagnosed in 43%.…”

Vocal Cord Dysfunction after an Inhalation Exposure

“…Supposedly, there were similarities between persons displaying exercise-induced VCD and persons experiencing exercise-induced laryngomalacia [62]. More extensive research suggested that exercise-induced inspiratory stridor could be an alternative movement of the supraglottic structures unresponsive to prescribed medications [57,[63][64][65]. Under the latter situation, VCD might just be a physiologic alteration where breathing restriction begins in a supraglottic structures and VCD happens as a secondary phenomenon [13].…”

“…Under the latter situation, VCD might just be a physiologic alteration where breathing restriction begins in a supraglottic structures and VCD happens as a secondary phenomenon [13]. In fact, Turmel et al utilized eucapneic voluntary hyperventilation to uncover cases of VCD and recommended dividing exercise-induced VCD into three categories: supraglottic, glottic and mixed (glottic and supraglottic) obstruction [63]. But besides VCD itself, there are other physiologic changes associated with intense exercise.…”

Irritants, Irritancy and Irritant Induced Asthma

“…Elite or intense-training athletes as well as swimmers, runners and cold-air athletes are at the greatest risk for VCD development [206,207,242]. Eucapneic voluntary hyperventilation testing can uncover some cases of VCD divided into three categories of supraglottic, glottic and mixed (glottic and supraglottic) upper airway obstruction [243].…”