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Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management.
Int J Pediatr Otorhinolaryngol. 2019 Dec; 127:109677.IJ

Abstract

INTRODUCTION

Exercise-induced laryngeal obstruction (EILO) affects 2-3% of the general population and 5.1% of elite athletes. Symptoms arise during high-intensity exercise and resolve at rest. EILO is often misdiagnosed as exercise-induced asthma as both conditions can present with dyspnea, chest tightness and cough. The purpose of this quality initiative was to identify patient characteristics that predict a higher likelihood of EILO, streamline referrals for exercise-endoscopy testing and avoid unnecessary medications.

METHODS

A retrospective chart review included patients referred to a pediatric tertiary center between 2013 and 2018 for suspected EILO requesting exercise endoscopy. Data was collected from the patient chart and referral letters included age, sex, physical activity, medications, symptoms, and results of pulmonary and cardiac function tests.

RESULTS

Between 2013 and 2018, 35 patients (9 males and 26 females, aged 5-18 years) were referred. Only 18 patients developed symptoms during an exercise endoscopy test. The majority were female (15/18), older than 10 years (18/18) and were involved in competitive sports (16/18). Stridor was the most common complaint among all patients referred (24/35) and many reported anxiety and high stress (15/35). The majority (63%) were previously treated with asthma medication. Pulmonary and cardiac function testing was not predictive of EILO.

CONCLUSION

EILO is typically present in adolescent females involved in competitive sports. Anxiety and high stress was commonly noted. The majority were treated with asthma medication even though pulmonary function testing was normal. Recognition of this patient profile should improve timely access to appropriate diagnostic assessments, avoid unnecessary medical treatment, and promote a return to optimal athletic performance.

Authors+Show Affiliations

Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.Translational Medicine, The Hospital for Sick Children, Toronto, Canada.Division of Respiratory Medicine, Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Canada.Translational Medicine, The Hospital for Sick Children, Toronto, Canada.Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: paolo.campisi@sickkids.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31526937

Citation

Campisi, Emma S., et al. "Exercise-induced Laryngeal Obstruction: Quality Initiative to Improve Assessment and Management." International Journal of Pediatric Otorhinolaryngology, vol. 127, 2019, p. 109677.
Campisi ES, Schneiderman JE, Owen B, et al. Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management. Int J Pediatr Otorhinolaryngol. 2019;127:109677.
Campisi, E. S., Schneiderman, J. E., Owen, B., Moraes, T. J., & Campisi, P. (2019). Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management. International Journal of Pediatric Otorhinolaryngology, 127, 109677. https://doi.org/10.1016/j.ijporl.2019.109677
Campisi ES, et al. Exercise-induced Laryngeal Obstruction: Quality Initiative to Improve Assessment and Management. Int J Pediatr Otorhinolaryngol. 2019;127:109677. PubMed PMID: 31526937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management. AU - Campisi,Emma S, AU - Schneiderman,Jane E, AU - Owen,Blythe, AU - Moraes,Theo J, AU - Campisi,Paolo, Y1 - 2019/09/11/ PY - 2019/06/19/received PY - 2019/09/07/revised PY - 2019/09/08/accepted PY - 2019/9/19/pubmed PY - 2020/2/7/medline PY - 2019/9/19/entrez KW - Exercise KW - Exercise-induced laryngeal obstruction KW - Paradoxical KW - Stridor SP - 109677 EP - 109677 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 127 N2 - INTRODUCTION: Exercise-induced laryngeal obstruction (EILO) affects 2-3% of the general population and 5.1% of elite athletes. Symptoms arise during high-intensity exercise and resolve at rest. EILO is often misdiagnosed as exercise-induced asthma as both conditions can present with dyspnea, chest tightness and cough. The purpose of this quality initiative was to identify patient characteristics that predict a higher likelihood of EILO, streamline referrals for exercise-endoscopy testing and avoid unnecessary medications. METHODS: A retrospective chart review included patients referred to a pediatric tertiary center between 2013 and 2018 for suspected EILO requesting exercise endoscopy. Data was collected from the patient chart and referral letters included age, sex, physical activity, medications, symptoms, and results of pulmonary and cardiac function tests. RESULTS: Between 2013 and 2018, 35 patients (9 males and 26 females, aged 5-18 years) were referred. Only 18 patients developed symptoms during an exercise endoscopy test. The majority were female (15/18), older than 10 years (18/18) and were involved in competitive sports (16/18). Stridor was the most common complaint among all patients referred (24/35) and many reported anxiety and high stress (15/35). The majority (63%) were previously treated with asthma medication. Pulmonary and cardiac function testing was not predictive of EILO. CONCLUSION: EILO is typically present in adolescent females involved in competitive sports. Anxiety and high stress was commonly noted. The majority were treated with asthma medication even though pulmonary function testing was normal. Recognition of this patient profile should improve timely access to appropriate diagnostic assessments, avoid unnecessary medical treatment, and promote a return to optimal athletic performance. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/31526937/Exercise_induced_laryngeal_obstruction:_Quality_initiative_to_improve_assessment_and_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(19)30430-6 DB - PRIME DP - Unbound Medicine ER -