Exercise-Induced Dyspnea: There is More to This Than Meets the Eye!-A Narrative Review

In the sporting community, symptoms of breathlessness during maximal exertion are common complaints in athletes, often mistaken for exercise-induced asthma and fail to respond to conventional asthma therapy. The possibility of laryngeal abnormalities including exercise-induced laryngeal obstruction (EILO) as the cause of symptoms is often overlooked due to a lack of clinical insight and awareness of this condition. We aimed to elucidate the relationship between upper airway obstruction at the glottic and supraglottic levels and exercise-induced dyspnea in recreational and competitive youth athletes. Second, we aimed to gain a broader understanding of the physiologic characteristics' indicative of EILO, its prevalence, and its consequences on athletic performance and diagnostics. A PUBMED search using keywords 'exercise-induced asthma or EILO' was performed to include 21 observational studies of youth athletes with EILO. Overall, the real-world evidence suggests that complaints of breathlessness, stridor and noisy breathing on inhalation during strenuous exercise are common in youth athletes that are often mistaken for exercise-induced asthma. Continuous laryngoscopy exercise is the gold standard for identifying laryngeal obstruction in relation to exercise. Glottic or supraglottic closure in response to maximal physical effort are features that differentiate EILO from asthma. Referral to a speech therapist for inspiratory muscle or respiratory retraining is the first line of treatment, and surgery for severe supraglottic dysfunction. In clinical practice, increasing awareness and adopting a systematic multidisciplinary approach investigating respiratory issues in youth athletes and efficient treatment strategies targeting EILO will enable the rapid resolution of symptoms, improve overall patient well-being, and optimise athletic performance.