Can flow-volume loops be used to diagnose exercise induced laryngeal obstructions? A comparison study examining the accuracy and inter-rater agreement of flow volume loops as a diagnostic tool

Prim Care Respir J. 2013 Sep;22(3):306-11. doi: 10.4104/pcrj.2013.00067.


Background: Pre- and post-exercise flow-volume loops are often recommended as an easy non-invasive method for diagnosing or excluding exercise-induced laryngeal obstructions in patients with exercise-related respiratory symptoms. However, at present there is no evidence for this recommendation.

Aims: To compare physician evaluated pre- and post-exercise flow-volume loops and flow data with laryngoscopic findings during exercise.

Methods: Data from 100 consecutive exercise tests with continuous laryngoscopy during the test were analysed. Laryngoscopic images were compared with the corresponding pre- and post-exercise flow-volume loops assessed by four separate physicians and with data from the loops (forced inspiratory flow (FIF) at 25% vs. FIF at 75% of forced inspiratory vital capacity (FIVC), forced expiratory flow at 50% of forced expiratory volume vs. FIF at 50% of FIVC, and FIVC vs. FIF at 50% of FIVC).

Results: There was no significant association between the laryngoscopic findings and the flow-volume data. There was no agreement between the four physicians in their assessment of the flow-volume loops (kappa <0.00), and none of the individual physician's assessments were significantly associated with the laryngoscopic findings.

Conclusions: Exercise-induced laryngeal obstructions cannot be diagnosed or excluded by physician evaluated pre- and post-exercise flow-volume loops or flow data alone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Airway Obstruction / diagnosis*
  • Airway Obstruction / etiology
  • Child
  • Cohort Studies
  • Exercise Test / methods*
  • Exercise*
  • Feasibility Studies
  • Female
  • Forced Expiratory Flow Rates
  • Forced Expiratory Volume
  • Humans
  • Inspiratory Capacity
  • Laryngeal Diseases / diagnosis*
  • Laryngeal Diseases / etiology
  • Laryngoscopy / methods
  • Male
  • Vocal Cord Dysfunction / diagnosis
  • Vocal Cord Dysfunction / etiology
  • Young Adult