Home > Pulmonology > NLC 2022 > EILO is often misdiagnosed

EILO is often misdiagnosed

Presented By
Dr Emil Walsted, Bispebjerg Hospital, Denmark
Conference
NLC 2022
Exercise-induced laryngeal obstruction (EILO) is often mistaken for asthma. In fact, it is a very different condition that needs a specific management strategy mainly focused on making the patient understand what EILO is. Speech training may also prove beneficial, but an inhaler should not be part of therapy.

Dr Emil Walsted (Bispebjerg Hospital, Denmark) explained that EILO is caused by the laryngeal structures which temporarily close during vigorous exercise. This phenomenon leads to exertional breathlessness, coughing during or after exercise, a (high-pitch or) wheezing sound on inspiration, and throat tightness. These symptoms resemble those of asthmatic patients, hence the frequent misdiagnosis. EILO is most frequently diagnosed in adolescents, with more young women than men presenting with the condition,” Dr Walsted added. “As it is often diagnosed as asthma, patients are prescribed asthma medication such as inhalers. These do not alleviate their symptoms and thus, patients are still limited regarding sports and exercise [1].”

Dr Walsted recommended taking a detailed history when patients present with the above-mentioned symptoms. “This includes a detailed description of episodes of dyspnoea, triggers such as exercise, irritants as well as localisation of the complaints (neck or chest), and presentation (debut, character, duration, frequency, etc.). Comorbidities should also be considered, such as asthma, dysfunctional breathing, psychiatric disorders (in particular anxiety), gastroesophageal reflux disease, and cardiac disease.”

EILO should be considered when asthma-like respiratory symptoms do not manifest themselves by using objective tests, when there is inspiratory stridor or ‘snoring’ (perhaps the patient can present a video or sound recording), if ‘exercise-induced asthma’ is suspected and short-acting beta-2 agonists have little or no effect, or when predictably sets in at moderate or high exercise intensity. The correct diagnosis is key, but putting the patient at ease is almost as important. “Experiencing EILO can be scary,” said Dr Walsted. “When patients know what is wrong and that they will not suffocate, this can help them to accept it, and help them deal with EILO.” Unnecessary therapy should be stopped, according to Dr Walsted. “Patients often receive asthma medication but they do not need it.” Treatments for EILO include respiratory training, speech therapy, inspiratory muscle training, and surgery in patients with predominantly supraglottic obstruction who have failed conservative therapy [2,3].

  1. Walsted ES, et al. ERJ Open Research. 2021;7:00195–2021.

  2. Clemm H, et al. Front Pediatr. 2022;10:817003.

  3. Walsted E. EILO. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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