Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights

Abstract

Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise-ILO can impair one's ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.

Exercise‐induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis

“…Munchausen stridor, psychogenic upper airway obstruction, emotional laryngeal wheezing, and factitious asthma are a few of the terms previously used to describe the disorder, which was poorly understood and thought to be exclusively of psychiatric origin. 1 In 2013, the European Respiratory Society, European Laryngological Society, and the American College of Chest Physicians proposed the umbrella term inducible laryngeal obstruction (ILO) be used to describe "inducible laryngeal obstructions causing breathing problems." 2(p446) The nomenclature system (2013 international consensus conference nomenclature) was developed to unify the field and provide a better framework for research findings to be communicated.…”

Physiotherapy improves symptoms of exercise-induced laryngeal obstruction in young elite athletes: a case series

“…There are few effective treatments for athletes with EILO. Treatment recommendations for exercise-induced closure at the glottic level include interventions used to manage vocal cord dysfunction, such as speech therapy,19–23 cognitive behavioural therapy24 and psychotherapy 25 26. Surgery is considered in cases of severe supraglottic obstruction 27–29.…”

Upper airway wheezing: Inducible laryngeal obstruction vs. excessive dynamic airway collapse

“…Etiologies related to this episodic phenomenon of intermittent glottic closure include exercise, airway irritants, reflux, and psychologic stressors. However, a direct physical irritant effect and laryngeal hypersensitivity has never been documented [10]. Poorly understood mechanisms secondary to emotional distress and exertion have previously been postulated and up to 25% of patients with exercise-induced ILO have underlining psychiatric conditions [[11], [12], [13]].…”