Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training

Astrid Sandnes, Tiina Andersen, Hege Havstad Clemm, Magnus Hilland, Maria Vollsæter, John-Helge Heimdal, Geir Egil Eide, Thomas Halvorsen, Ola Drange Røksund, Astrid Sandnes, Tiina Andersen, Hege Havstad Clemm, Magnus Hilland, Maria Vollsæter, John-Helge Heimdal, Geir Egil Eide, Thomas Halvorsen, Ola Drange Røksund

Abstract

Background: Exercise-induced laryngeal obstruction (EILO) is common in athletes and presents with dyspnoea, chest tightness, inspiratory stridor and sometimes panic reactions. The evidence for conservative treatment is weak, but case reports suggest effects from inspiratory muscle training (IMT). We aimed to explore effects from IMT used in athletes with EILO.

Method: Twenty-eight athletes, mean age 16.4 years, diagnosed with EILO at our clinic, participated in a 6-week treatment programme, using a resistive flow-dependent IMT device (Respifit S). Four athletes competed at international level, 13 at national and 11 at regional levels. Video-recorded continuous transnasal flexible laryngoscopy was performed from rest to peak exercise (continuous laryngoscopy exercise (CLE) test) and scored before and 2-4 weeks after the training period. Ergospirometric variables were obtained from this CLE set-up. Lung function was measured according to guidelines. Symptom scores and demographic variables were obtained from a questionnaire.

Results: After the treatment period, symptoms had decreased in 22/28 (79%) participants. Mean overall CLE score had improved after treatment (p<0.001), with the scores becoming normal in five athletes but worse in two. Most of the improvement was explained by changes at the glottic laryngeal level (p=0.009). Ergospirometric variables revealed significantly higher peak minute ventilation explained by higher tidal volumes and were otherwise unchanged.

Conclusion: This explorative study underlines the heterogeneous treatment response of EILO and suggests that IMT may become an efficient conservative treatment tool in subgroups, possibly contributing to better control of the vocal folds. The signals from this study should be tested in future controlled interventional studies.

Keywords: CLE; EILO; continuous laryngoscopy exercise test; exercise; glottic; inspiratory muscle training; larynx; supraglottic; vocal cord dysfunction.

Conflict of interest statement

Competing interests: Haukeland University Hospital owns parts of US patent No. 11/134551, protecting the commercial rights of the CLE test.

Figures

Figure 1
Figure 1
Grading system according to Maat et al reproduced with permission.
Figure 2
Figure 2
CLE scores before and after treatment with IMT of 28 athletes consecutively referred for work-up of EIIS and diagnosed with EILO at the outpatient clinic at the Pediatric Department of Haukeland University Hospital in Bergen, Norway between May 2012 and May 2014. Dots represent mean values, and vertical lines represent 95% confidence intervals. CLE-scores, Continuous laryngoscopy exercise test (0-3); IMT, Inspiratory Muscle training; EIIS, Exercise induced inspiratory symptoms; EILO, Exercise induced laryngeal obstruction.

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