Not all wheeze is asthma: time for patients toexercisetheir rights

Abstract

It is now over a century since Sir William Osler first highlighted the fact that not all breathlessness and wheeze is caused by asthma; with a description that in some, … 'the laryngeal muscle can spasm during periods of stress' and as such act to mimic bronchoconstriction.

Bronchial provocation testing does not detect exercise-induced laryngeal obstruction

“…The presence of EILO might affect how subjects report asthma symptoms, which could lead to incorrect diagnosis and the inappropriate use of medication. This confirms the importance of objective testing in making an accurate diagnosis of asthma [5], however, further work is needed to understand the consequences of EILO with regards to the use of asthma medication.…”

“…Thus, objective testing is strongly recommended to ensure secure diagnosis [5]. Considering a prevalence in unselected populations of 6%--8% [6; 7] and as high as 35% in our previous study of a selected population of athletes WalstedNielsen 2013, EILO is an important differential diagnosis to consider in the asthma clinic; not only in athletes but also in any subject presenting with otherwise unexplained exertional dyspnoea Hull 2012.…”

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

“…indirect bronchoprovocation challenges and/or continuous laryngoscopy during exercise testing) (22).…”

Exercise-induced laryngeal obstruction: a common and overlooked cause of exertional breathlessness

“…Such patients are often diagnosed with exercise-induced asthma and prescribed a short-acting bronchodilator. 1 Recently there has been increasing recognition that an alternative diagnosis should be considered, 2 specifically a condition termed exerciseinduced laryngeal obstruction (EILO), a phenomenon in which closure of the larynx occurs during high-intensity exercise. This narrowing causes a significant reduction in airflow, thereby precipitating breathlessness and wheeze.…”