Overuse of asthma medications in athletes with EILO

Abstract

Background: Exercise induced laryngeal obstruction (EILO) affects 5-7% of young people and up to 35% of athletes. Despite distinctly different symptom patterns, EILO is often confused with exercise induced asthma (EIA), leading to overuse of asthma medication with no effect. Recent research has suggested at least two phenotypes of EILO, but knowledge on this is scarce in athletes. We aimed to study the phenotypic presentation of EILO in athletes, and the occurrence of misdiagnosed asthma. Material and Methods: A study based on the EILO register at Haukeland University Hospital, Bergen, Norway. All patients included competed on a national or international level, and were tested with continuous laryngoscopy during exercise (CLE) in the period 2013-2016. CLE-test data and information from a standardized questionnaire were assessed. Results: Of 116 tested athletes (age range 13-32 years, mean 18), 72 (62%) had findings compatible with EILO. Inappropriate adduction of supraglottic structures were the main findings in 46 (64%), whereas a predominant glottic EILO was diagnosed in 20 (28%) athletes. Asthma medications had been used by 96 (83%), of whom half reported little/no effect. Current asthma was reported by 34 (29%) athletes, of whom nine had glottic EILO, 10 supraglottic EILO and 10 normal CLE-test findings. Conclusion: EILO is common in athletes complaining of breathing difficulties. Supraglottic obstruction was the main problem, but glottic EILO was more common in these athletes than in previous studies of unselected patients. The overuse of asthma medication was high, confirming the high risk of misdiagnosing and maltreating athletes with EILO.