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Larynx during exercise: the unexplored bottleneck of the airways.
Eur Arch Otorhinolaryngol. 2015 Sep; 272(9):2101-9.EA

Abstract

Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.

Authors+Show Affiliations

Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway, odro@helse-bergen.no.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

25033930

Citation

Røksund, Ola Drange, et al. "Larynx During Exercise: the Unexplored Bottleneck of the Airways." European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated With the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, vol. 272, no. 9, 2015, pp. 2101-9.
Røksund OD, Heimdal JH, Olofsson J, et al. Larynx during exercise: the unexplored bottleneck of the airways. Eur Arch Otorhinolaryngol. 2015;272(9):2101-9.
Røksund, O. D., Heimdal, J. H., Olofsson, J., Maat, R. C., & Halvorsen, T. (2015). Larynx during exercise: the unexplored bottleneck of the airways. European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated With the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 272(9), 2101-9. https://doi.org/10.1007/s00405-014-3159-3
Røksund OD, et al. Larynx During Exercise: the Unexplored Bottleneck of the Airways. Eur Arch Otorhinolaryngol. 2015;272(9):2101-9. PubMed PMID: 25033930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Larynx during exercise: the unexplored bottleneck of the airways. AU - Røksund,Ola Drange, AU - Heimdal,John-Helge, AU - Olofsson,Jan, AU - Maat,Robert Christiaan, AU - Halvorsen,Thomas, Y1 - 2014/07/18/ PY - 2014/01/20/received PY - 2014/06/15/accepted PY - 2014/7/19/entrez PY - 2014/7/19/pubmed PY - 2016/3/5/medline SP - 2101 EP - 9 JF - European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery JO - Eur Arch Otorhinolaryngol VL - 272 IS - 9 N2 - Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes. SN - 1434-4726 UR - https://www.unboundmedicine.com/medline/citation/25033930/Larynx_during_exercise:_the_unexplored_bottleneck_of_the_airways_ L2 - https://dx.doi.org/10.1007/s00405-014-3159-3 DB - PRIME DP - Unbound Medicine ER -