Exercise inducible laryngeal obstruction: diagnostics and management

Paediatr Respir Rev. 2017 Jan;21:86-94. doi: 10.1016/j.prrv.2016.07.003. Epub 2016 Jul 18.

Abstract

Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.

Keywords: EIA; EIIS; EILO; Exercise Induced Asthma; Exercise Induced Inspiratory Symptoms; Exercise Induced Laryngeal Obstruction; Larynx; Respiratory Sounds; VCD.; Vocal Cord Dysfunction.

Publication types

  • Review

MeSH terms

  • Airway Obstruction / diagnosis*
  • Airway Obstruction / etiology
  • Airway Obstruction / physiopathology
  • Airway Obstruction / therapy
  • Breathing Exercises
  • Exercise Test
  • Exercise*
  • Humans
  • Laryngeal Diseases / diagnosis*
  • Laryngeal Diseases / etiology
  • Laryngeal Diseases / physiopathology
  • Laryngeal Diseases / therapy
  • Laryngoplasty
  • Laryngoscopy*
  • Patient Education as Topic
  • Respiratory Therapy