Thank you for the comments provided in the letter to the editor by Hull et al. (1), in reference to my recent journal review article on the medical care of the aquatics athlete (2). The letter draws attention to the omission of the subject of upper airway disorders. The decision to include exercise-induced bronchoconstriction and to exclude upper airway disorders was based on both the relative prevalence of the conditions and the publication word count limitations. A modified version of the Hull et al. letter (1) would fit appropriately in a more comprehensive review of the medical conditions affecting swimmers.
The letter offers strong justifications for the inclusion of such upper airway disorders such as rhinitis, atopy, and exercise-induced laryngeal obstruction (EILO). The most thought-provoking contents of the letter involve the diagnosis and treatment of EILO. The authors acknowledge the difficulties in establishing a diagnosis of EILO by traditional methodology and yet express confidence in their ability to diagnose the condition poolside, largely on the basis of clinical presentation. Although many clinicians, including myself, have found it a challenge to treat EILO, the authors report inspiring success in treating EILO via a combination of inspiratory muscle and breathing relaxation training. I respectfully urge the authors to publish details of their EILO diagnosis method and treatment protocols in athletes, so that we all may improve our skills in treating the aquatics athlete.
Andrew W. Nichols, MD, FACSM
Department of Family Medicine and Community Health
John A. Burns School of Medicine
and Office of Student Affairs
University of Hawaii at Manoa
1. 1. Hull JH, Scadding G, Dickinson J, Greenwell J. Medical care of aquatic athlete — don’t overlook the upper airway. Curr. Sports Med. Rep.
2016; 15: 46.
2. Nichols AW. Medical care of the aquatics athlete. Curr. Sports Med. Rep.
2015; 14: 389–96.