Exercise-induced laryngeal obstruction (EILO) is often misdiagnosed

Exercise-induced laryngeal obstruction (EILO) is often mistaken for asthma. In fact, it is a very different condition that needs a specific management strategy mainly focused on patient awareness. Respiratory and speech training may also prove beneficial, but an inhaler should not be part of therapy (unless the patient has concomitant asthma).

Dr Emil Walsted (Bispebjerg Hospital, Denmark) explained that EILO is caused by narrowing of the laryngeal structures (at the level of the vocal cords or in the supraglottic area) which occurs during vigorous exercise. “This phenomenon leads to exertional breathlessness, coughing during or after exercise, a (high-pitch or) wheezing sound on inspiration, and throat tightness. These symptoms resemble those of asthma, hence the frequent misdiagnosis. EILO is most frequently diagnosed in adolescents, with more young women than men presenting with the condition,” Dr Walsted added. “As it is often diagnosed as asthma, patients are prescribed asthma medication such as inhalers. These do not alleviate their symptoms and thus, patients are still limited regarding sports and exercise [1].”

Dr Walsted recommended taking a detailed history when patients present with the above-mentioned symptoms. “This includes a detailed description of episodes of dyspnoea, triggers such as exercise, irritants as well as localisation of the complaints (neck or chest), and presentation (symptoms’ onset, characteristics, duration, frequency, etc.). Comorbidities should also be considered, such as asthma, dysfunctional breathing, psychiatric disorders (in particular anxiety), gastroesophageal reflux disease (GERD), and cardiac disease.”

EILO should be considered when asthma-like respiratory symptoms do not become manifest on objective (lung function) tests, when there is inspiratory stridor or ‘snoring’ (the patient may be able to present a video or sound recording), if ‘exercise-induced asthma’ is suspected and asthma-reliever medication has little or no effect, or when sets in at moderate/high exercise intensity. While correct diagnosis is key, reassurance of the patient is equally important. “Experiencing EILO can be scary,” explained Dr Walsted. “When EILO is demonstrated during the medical examination, patients might be able to understand the mechanism and that they will not suffocate, this can help them to accept and deal with EILO.” Unnecessary therapy should be stopped, according to Dr Walsted. “Patients often receive asthma medication which they do not need.” Treatments for EILO include respiratory training, speech therapy, inspiratory muscle training, and surgery in patients with predominantly supraglottic obstruction who have failed conservative therapy [2,3].

1. Walsted ES, et al. ERJ Open Research. 2021;7:00195–2021.
2. Clemm H, et al. Front Pediatr. 2022;10:817003.
3. Walsted E. EILO. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August, 202216 August, 2022