Abstract
ABSTRACT Background: Patients suffering from exercise-induced laryngeal obstruction (EILO) are subjected to several exhausting tests. We aimed to assess the feasibility of using a single test to obtain diagnostic measurements for maximum oxygen uptake (VO2max) and exercise-induced laryngeal obstruction (EILO). Methods: Patients referred to the outpatient respiratory clinic at the University Hospital of Bispebjerg, Copenhagen with exercise-induced dyspnoea were evaluated for inclusion over 13 months. Eligible patients were aged 18–43 years, had a known EILO diagnosis (moderate or severe) and were inactive (self-reported activity) with less than 3 hours activity per week. In randomised order, all participants (n = 11) underwent three tests: a VO2max test with and without concurrent laryngoscopy. VO2max and EILO values from the two testing methods were compared. Findings: There was no difference in VO2max measured by ergospirometry with and without simultaneous continuous laryngoscopy during exercise (CLE) testing (mean difference −22 ml O2･min−1; 95% CI −125 to 81 ml O2･min−1; P = 0.647). EILO scores obtained during the CLE testing on the treadmill versus CLE testing on the ergometer bike revealed identical supraglottic scores in nine of the 11 participants (82%) with substantial agreement between the two types of test (x = 0.71). Glottic scores were identical in six of the 11 (55%), showing moderate agreement between test types (x = 0.38). Conclusions: Based on our findings in inactive individuals, ergospirometry with laryngoscopy is feasible and well tolerated, yielding measurements for maximal oxygen uptake comparable to those of standard bike ergospirometry. Likewise, measurements of supraglottic EILO are comparable to those of the standard treadmill CLE test.
Highlights
Assessment of exercise responses provides critical information when evaluating patients with, or suspected of having, cardiovascular or pulmonary diseases.[1]
The mean difference in maximal oxygen uptake measured by ergospirometry with and without simultaneous continuous laryngoscopy during exercise (CLE) testing was −22 ml O2・min−1 (Table 2)
The mean respiratory exchange ratio (RER) at peak exercise was 1.17 when measured with CLE and 1.24 when measured with ergospirometry alone (P = 0.1) (Table 3); there were no differences in maximum heart rates (P = 0.6), maximum achieved watt (P = 0.8), BORG rating of perceived exertion scale (RPE) (P = 0.1) or test duration (P = 0.8)
Summary
Assessment of exercise responses provides critical information when evaluating patients with, or suspected of having, cardiovascular or pulmonary diseases.[1]. Visualisation of the larynx when a patient is symptomatic (i.e. during exercise) is crucial to detect EILO and to determine how the laryngeal structures are affected.[11,12] The clinician needs this detailed recording of laryngeal movement when evaluating a patient and when assessing the possible benefit of interventions such as speech- and language therapy or surgery Other techniques, such as inspiratory flow-volume curves,[13,14] bronchoprovocation testing [11,14,15] and flexible fibre optic laryngoscopy pre- and post-exercise,[9,16] do not provide reliable and accurate information about EILO. We aimed to assess the feasibility of using a single test to obtain diagnostic measurements for maximum oxygen uptake (VO2max) and exercise-induced laryngeal obstruction (EILO)
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