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High Prevalence of Exercise-Induced Laryngeal Obstruction in Athletes


Medicine & Science in Sports & Exercise: November 2013 - Volume 45 - Issue 11 - p 2030–2035
doi: 10.1249/MSS.0b013e318298b19a
Clinical Sciences

Introduction Unexplained respiratory symptoms reported by athletes are often incorrectly considered secondary to exercise-induced asthma. We hypothesized that this may be related to exercise-induced laryngeal obstruction (EILO). This study evaluates the prevalence of EILO in an unselected cohort of athletes.

Methods We retrospectively reviewed the prevalence of EILO in a cohort of athletes (n = 91) referred consecutively during a 2-yr period for asthma workup including continuous laryngoscopy during exercise (CLE) testing. We compared clinical characteristics and bronchial hyperreactivity between athletes with and without EILO.

Results Of 88 athletes who completed a full workup, 31 (35.2%) had EILO and 38 (43.2%) had a positive bronchoprovocation or bronchodilator reversibility test. The presence of inspiratory symptoms did not differentiate athletes with and without EILO. Sixty-one percent of athletes with EILO and negative bronchoprovocation and bronchodilator reversibility tests used regular asthma medication at referral.

Conclusions In athletes with unexplained respiratory symptoms, EILO is an important differential diagnosis not discerned from other etiologies by clinical features. These findings have important implications for the assessment and management of athletes presenting with persistent respiratory symptoms despite asthma therapy.

1Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, DENMARK; and 2Department of Respiratory Medicine, Royal Brompton Hospital, London, England, UNITED KINGDOM

Address for correspondence: Emil Walsted Nielsen, M.B., Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark; E-mail:

Submitted for publication February 2013.

Accepted for publication April 2013.

© 2013 American College of Sports Medicine