Exercise-induced laryngeal obstruction in children and adolescents: are we listening?

Abstract

Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered ‘rare’ though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.

Dysfunctional Breathing in Children: A Literature Review

“…For some individuals, depending on the severity of pre-existing anxieties or those caused by this condition, formal psychological support may be required. If a more significant psychosocial disturbance is identified, it should be addressed in the appropriate way [55]. A clinical psychologist may assess and formulate an illustration of the psychological effects of respiratory disease.…”

Keeping Pace with Adolescent Asthma: A Practical Approach to Optimizing Care

“…Of particular interest in adolescents, patients who report breathlessness and noisy breathing during rest or exercise may have inducible laryngeal obstruction (ILO) [ 11 ]. ILO that occurs during exercise can be due to exercise-induced laryngeal obstruction (EILO) [ 12 ]. This oft-under-recognized entity presents with inspiratory stridor, throat tightness, maximal breathlessness during exertion and resolution upon rest [ 13 ], or changes in voice post-exercise [ 14 ].…”

Clinical Profiles of Children and Adolescents With Induced Laryngeal Obstruction (ILO) and Exercise Induced Laryngeal Obstruction (EILO)

“…[22][23][24] It is also common for patients with EILO to experience secondary emotional or environmental triggers. 25 Nomenclature for this EILO subtype has not been established, but will henceforth be referred to as EILO+ (EILO+ secondary triggers).…”