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

Clemm, Hege; Olin, J. Tod; McIntosh, Cameron N.; Schwellnus, Martin; Sewry, Nicola; Hull, James H.; Halvorsen, Thomas

doi:10.1136/bjsports-2021-104704

Cited by 46 publications

(42 citation statements)

References 87 publications

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“…EILO can mimic LAD (asthma and/or EIB), may impair exercise performance81 and is, therefore, an important cause of non-infective ARill in athletes. A detailed review of EILO in the athlete was specifically commissioned for this IOC Consensus statement and has been published 82…”

Section: Exercise-induced Laryngeal Obstructionmentioning

confidence: 99%

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Schwellnus

Adami²,

Bougault

et al. 2022

Br J Sports Med

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Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to ‘core’ members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

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Section: Exercise-induced Laryngeal Obstructionmentioning

confidence: 99%

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Schwellnus

Adami²,

Bougault

et al. 2022

Br J Sports Med

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“…Asthma/EIB and EILO can also co-exist, further challenging treatment decisions [10,11]. EILO is diagnosed by continuously visualizing the larynx with a flexible laryngoscope during maximal exercise (CLE-test) [12].…”

Section: Contributors' Statementmentioning

confidence: 99%

“…Symptoms of EILO can be misinterpreted as asthma/exercise-induced bronchoconstriction (EIB), a situation that may lead to mismanagement of both conditions [ 7 – 9 ]. Asthma/EIB and EILO can also coexist, further challenging treatment decisions [ 10 , 11 ]. EILO is diagnosed by continuously visualising the larynx with a flexible laryngoscope during maximal exercise (continuous laryngoscopy exercise (CLE) test) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended

Muralitharan

Carlsen²,

Delestre-Levai³

et al. 2022

ERJ Open Res

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IntroductionExercise induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training (IMT), or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic-receptor antagonist used to treat asthma, and suggested in a few reports to improve EILO symptoms.AimTo investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE-scores.MethodsA randomized crossover trial, conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE-score≥3 (range 0–12). Two consecutive CLE-tests were performed within two weeks, one test with and one test without prior administration of inhaled IB in a randomized order. Main outcomes were the CLE-score, dyspnoea measured using a modified BORG scale (range 0–10) and cardiopulmonary exercise data provided by the CLE-test.ResultsTwenty participants (14 females) aged 12–25 years participated, and all ran to exhaustion on both tests. Mean CLE-score, Borg score, and peak oxygen consumption were similar in tests performed with and without IB, mean differences (95% confidence interval) were 0.08 (−0.28 to 0.43), 0.35 (−0.29 to 0.99), and −0.4 (−1.9 to 1.1) ml−1kg·min−1, respectively.ConclusionInhaled IB did not improve CLE-score, dyspnoea, or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.

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“…EILO can occasionally be replicated by asking the patient to exert themselves then inserting the nasendoscope, however the diagnostic EILO images may be elusive due to rapid offset of abnormal laryngeal movements. As such, evidence of EILO should be sought by continuous laryngoscopy in exercise (CLE) as seen in Figure 3 , preferably with the type of exercise that usually triggers an individual's symptoms ( 25 ).…”

Section: Inducible Laryngeal Obstructionmentioning

confidence: 99%

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

2022

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Paroxysms of dyspnoea in the general population are commonly reported and are frequently assumed to be asthma-related, especially if this diagnostic label has been previously applied. Often, this is not the case. Inducible Laryngeal Obstruction (ILO) and Dysfunctional Breathing (DB) are common comorbid conditions that go unrecognised in many difficult-to-treat asthmatics. On average, these patients have a delay in diagnosis of almost 5 years. This delay, along with ineffective, inappropriate escalation of asthma therapy, frequent hospital presentations for uncontrolled symptoms, and even intensive care admissions, magnifies patient morbidity and poor quality of life. ILO and DB have similar presentations and triggers to asthma. Differentiating between them can be challenging, especially in centres that do not have access to multidisciplinary subspecialty asthma services. Objectively confirming the diagnosis can likewise be challenging as symptoms fluctuate, and gold-standard investigations require extensive experience. This mini-review will summarise the clinical features of ILO and DB, with particular focus in the context of individuals treated for asthma. This narrative review will define each condition, highlight poignant aspects of the history and describe elements of the diagnostic pathway to gain objective confirmation.

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

Cited by 46 publications

References 87 publications

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

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