Inducible Laryngeal Obstruction in the Paediatric Population – Review of the Literature and Current Understanding

Abstract

Inducible laryngeal obstruction (ILO) is a complex entity and its exact mechanisms are still unclear. It is characterised by transient and reversible narrowing of the larynx in response to external triggers, resulting in symptoms such as cough, dyspnoea and noisy breathing. The prevalence of this condition in adult or paediatric populations is uncertain. Management of ILO starts by establishing an accurate diagnosis, and treatment includes control of trigger factors, breathing and relaxation techniques, and speech and respiratory therapy. The aim of this article is to summarise current understanding and provide a review of the literature of ILO in the paediatric population.

Breathing pattern disorders (dysfunctional breathing) characteristics and outcomes of children and young people attending a secondary care respiratory clinic

“…The median age at diagnosis, 14 years, is similar to age reported for ILO, 14.5 years, and the predominance of females was 3.5:1, slightly higher than ILO, 2.3:1. 1 The slight differences may reflect the inclusion of all BPD rather than just ILO in our cases.…”

“…This confirms the need for screening for BPD in difficult to control adolescent asthma, as recently outlined by Connett et al This seems to be in contrast with adult series where EILO occurs more frequently as a single entity. 1 Inducers of the BPD are important to recognize, as reflected by previous studies. Exercise was the most common inducer, with swimming and competitive sport being most cited and bullying from coaches being seen as a major factor.…”

“…Inducible laryngeal obstruction (ILO) is a well-recognized disorder most commonly associated with exercise (exercise-induced laryngeal obstruction [EILO]), encompassing obstruction that occurs at supraglottic and glottic level, which can be demonstrated by laryngoscopy. [1][2][3] BPDs can now encompass a wide range of characteristic symptoms: dyspnea at rest (sudden and unexplained) or on exercise, wheezing, cough, stridor, upper chest pain or tightness, yawning, and throat discomfort. Typical patterns include EILO, ILO (due to other stimuli, for example anxiety), hyperventilation, dysphonia, psychogenic cough, and other irregular breathing patterns, such as sighing.…”

Planning a digital intervention for adolescents with asthma (BREATHE4T): A theory‐, evidence‐ and Person‐Based Approach to identify key behavioural issues

“…The prevalence of dysfunctional breathing in children is currently unknown, however one study suggests it may be experienced by as many as 55% of children and adolescents with asthma 12,13 . It is sometimes known as hyperventilation, vocal cord dysfunction or inducible laryngeal obstruction 12,14–16 . It is characterised by increased respiratory rate, the inappropriate use of accessory muscles and paradoxical vocal cord movement 12,16 .…”

“…12,13 It is sometimes known as hyperventilation, vocal cord dysfunction or inducible laryngeal obstruction. 12,[14][15][16] It is characterised by increased respiratory rate, the inappropriate use of accessory muscles and paradoxical vocal cord movement. 12,16 Dysfunctional breathing can exacerbate asthma symptoms, further impact quality of life and increase anxiety.…”