Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights

Abstract

Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise--ILO can impair one’s ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.

Keywords:

• Continuous laryngoscopy during exercise
• exercise-induced laryngeal obstruction
• exertional dyspnea
• inducible laryngeal obstruction
• paradoxical vocal fold motion
• vocal cord dysfunction

Acknowledegments

The authors acknowledge all contributors in the Upper Airway Working Group, based at National Jewish Health, for their insights into this and future projects. The authors also thank George Zeman, Valerie Keever, Mark Fleming, Dave Gurka, and Lisa Fails for their support of continuous laryngoscopy during exercise as well as D Sundstrom and Dusty Christian for their assistance in coordinating the research group.

Declaration of interest

M. J. Morris has been a speaker for Boehringer-Ingelheim. K. L. Christopher is on the advisory boards for ILO International Task Force, National Association for Medical Direction of Respiratory Care, and the American Association for Respiratory Care, and is employed by and holds a patent with CS Medical, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.