EXERCISE-INDUCED LARYNGEAL OBSTRUCTION IN ATHLETES: AN UNDERRECOGNIZED CAUSE OF EXERTIONAL DYSPNEA, DIAGNOSTIC CONFUSION WITH ASTHMA, AND IMPAIRED EXERCISE TOLERANCE - A NARRATIVE REVIEW

Abstract

Background: Exertional dyspnea is a clinically relevant symptom in athletes, particularly during high-intensity exercise. Although asthma and exercise-induced bronchoconstriction are commonly considered in this context, exercise-induced laryngeal obstruction (EILO) is represents an important upper-airway cause of exertional breathlessness that may remain underdiagnosed. Its symptomatic overlap and possible coexistence with lower-airway disease may contribute to diagnostic confusion, ineffective treatment and impaired sport participation.

Aim: The aim of this narrative review was to synthesize current evidence on EILO in athletes, with emphasis on clinical presentation, diagnostic confusion with asthma and exercise-induced bronchoconstriction, effects on exercise tolerance, and available diagnostic and therapeutic strategies.

Methods: A targeted literature review of peer-reviewed publications concerning EILO, inducible laryngeal obstruction, exertional respiratory symptoms in athletes, asthma, exercise-induced bronchoconstriction, continuous laryngoscopy during exercise and treatment strategies was performed. Evidence was synthesized narratively and organized into clinically relevant thematic sections.

Results: EILO is characterized by transient narrowing of the laryngeal airway during exercise, usually under conditions of high ventilatory demand. Symptoms typically occur during peak exercise and may include inspiratory dyspnea, throat tightness, noisy breathing or stridor. The available literature indicates that EILO is clinically relevant among adolescents and athletes, particularly in symptomatic and referral-based cohorts. Because symptoms may mimic or coexist with asthma and exercise-induced bronchoconstriction, objective assessment of both upper- and lower-airway function is often required. Continuous laryngoscopy during exercise remains the current diagnostic reference standard. Management is usually conservative and may include education, speech therapy, breathing retraining, physiotherapy and inspiratory muscle training, while surgery is reserved for selected severe supraglottic cases.

Conclusions: EILO should be considered in athletes with persistent, unexplained or atypical exertional dyspnea, especially when symptoms are predominantly inspiratory, occur during peak exercise and respond inadequately to asthma-directed treatment. Early recognition and objective assessment may reduce diagnostic delay, limit ineffective management and support maintenance of exercise tolerance, training quality and sport participation.