Asthma is the most common breathing problem that occurs with exercise. Another common, although lesser known, cause of shortness of breath experienced by athletes is exercise-induced laryngeal obstruction (EILO).
Asthma is a breathing problem defined by airway obstruction within the lungs caused by a combination of:
1. Inflammation (irritation and swelling) of the lining of the airways
2. Bronchospasm (tightening of the muscles that surround the airways)
3. Mucus production
The deep, rapid breathing that normally occurs during vigorous exercise leads to inhaling cooler, drier air, which can trigger bronchospasm in affected individuals.
EILO is a respiratory disease characterized by airway obstruction in the throat. Throat obstruction occurs due to the inappropriate, partial closure of the vocal cords and nearby structures during high-intensity exercise. EILO was previously known as vocal cord dysfunction (VCD).
• Asthma affects more than 300 million people globally and roughly 10% of the youth population.
• There is an uneven distribution of asthma morbidity across race and ethnicity with slightly higher rates in African-American and Hispanic populations.
• Most people with asthma experience symptoms during exercise.
• Most people with exercise-induced asthma have the disease which is present outside of exercise as well.
• For most athletes with asthma, signs of a problem may not be obvious to observers.
• Athletes with mild acute asthma symptoms may experience coughing, chest tightness, shortness of breath, and wheezing.
• Athletes with more severe limitation from asthma may experience fast breathing, difficulty breathing or speaking, retractions, and cyanosis (turning blue). These are often referred to as signs of respiratory distress.
• Athletes or adults should administer a quick-relief bronchodilator medication such as albuterol.
• Most inhalers should be administered with a spacer device, unless otherwise specified by the inhaler instructions, to optimize medication delivery to the lungs.
• If there is no reduction in symptoms despite appropriate use of a quick-relief medication, or if signs of respiratory distress are observed, adults should refer the athlete for immediate medical attention or call 911.
• For the vast majority of athletes with asthma, baseline and exercise-induced symptoms should be well controlled with medication(s). If this does not seem to be the case, coaches, trainers, and parents should encourage further evaluation by a medical provider for optimization of therapy and consideration of other diagnoses that present with similar symptoms.
• EILO most commonly occurs in motivated, competitive, high-achieving athletes in their teens or 20s.
• EILO is often confused with asthma because the two respiratory diseases share similar symptoms. EILO symptoms and signs are typically more obvious to observers than asthma symptoms and signs.
• Common symptoms of EILO include: severe shortness of breath that is “scary” to the athlete and obvious/concerning to observers.
• The athlete with EILO may feel like he/she is “breathing through a straw” with symptoms of hyperventilation (fast breathing, pallor, dizziness, lightheadedness, nausea, numbness/tingling).
• Observers may hear stridor (a high-pitched gasping sound when the athlete inhales).
• Asthma medications do not help EILO.
• Athletes should perform controlled breathing and relaxation exercises (if known) to abort the symptoms without notable intervention from others.
• Coaches, trainers, parents, and teammates should be cognizant that drawing excessive attention to the problem can actually worsen symptoms.
• Athletes who present with these symptoms but are not receiving treatment specifically for EILO should consider seeking further evaluation.
• Athletes, parents, coaches and trainers should be aware that excellent control of this condition can be achieved with respiratory retraining therapy, typically directed by a speech pathologist and/or a pulmonologist with expertise in EILO evaluation and treatment.
National Jewish Health
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