Exercise-Induced Laryngeal Obstruction in Athletes with Exertional Dyspnoea: A Narrative Review of Diagnostic Challenges, Management and Sport Participation
DOI:
https://doi.org/10.12775/QS.2026.59.72749Keywords
exercise-induced laryngeal obstruction, athletes, exertional dyspnoea, continuous laryngoscopy during exercise, exercise-induced bronchoconstriction, asthmaAbstract
Background. Exercise-induced laryngeal obstruction (EILO) is a transient, exercise-triggered narrowing of the laryngeal inlet that may mimic asthma and exercise-induced bronchoconstriction (EIB). In athletes, this confusion delays mechanism-specific assessment and may lead to unnecessary lower-airway treatment.
Aim. To synthesise current evidence on EILO in athletes with exertional dyspnoea, focusing on differentiation from EIB and asthma, continuous laryngoscopy during exercise (CLE), management and sport participation.
Materials and methods. PubMed/MEDLINE, Google Scholar, the Cochrane Library, ClinicalTrials.gov and reference lists of key papers were searched from database inception to 10 May 2026, restricted to publications in English and Polish. Consensus statements took precedence, followed by guidelines, CLE studies and intervention trials.
Results. Inspiratory, noisy breathlessness at peak workload with rapid recovery suggests EILO but does not confirm it. Asthma and EIB require lower-airway testing, whereas EILO is best confirmed by CLE during symptom-reproducing exercise. Strong conclusions emerge only when timing, exertion level, symptom pattern, site of obstruction and degree of closure align coherently. Non-surgical approaches rest largely on limited observational data, with one recent randomised trial showing no difference between video biofeedback and respiratory retraining in broader inducible laryngeal obstruction populations. Supraglottoplasty is reserved for severe supraglottic disease refractory to conservative management.
Conclusions. EILO is a distinct upper-airway mechanism. Diagnostic evidence is stronger than treatment and return-to-sport evidence. Treatment decisions and sport reporting should reflect symptom–mechanism concordance and sport-specific tolerance.
References
1. Schwellnus M, Adami PE, Bougault V, Budgett R, Clemm HH, Derman W, et al. International Olympic Committee consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness. Br J Sports Med. 2022;56(19):1089–1103. https://doi.org/10.1136/bjsports-2022-105567
2. Weiss P, Rundell KW. Imitators of exercise-induced bronchoconstriction. Allergy Asthma Clin Immunol. 2009;5(1):7. https://doi.org/10.1186/1710-1492-5-7
3. Hull JH, Ansley L, Robson-Ansley P, Parsons JP. Managing respiratory problems in athletes. Clin Med (Lond). 2012;12(4):351–356. https://doi.org/10.7861/clinmedicine.12-4-351
4. Røksund OD, Maat RC, Heimdal JH, Olofsson J, Skadberg BT, Halvorsen T. Exercise induced dyspnea in the young. Larynx as the bottleneck of the airways. Respir Med. 2009;103(12):1911–1918. https://doi.org/10.1016/j.rmed.2009.05.024
5. Clemm HH, Olin JT, McIntosh C, Schwellnus M, Sewry N, Hull JH, et al. Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on ‘acute respiratory illness in the athlete’. Br J Sports Med. 2022;56(11):622–629. https://doi.org/10.1136/bjsports-2021-104704
6. Liyanagedara S, McLeod R, Elhassan HA. Exercise induced laryngeal obstruction: a review of diagnosis and management. Eur Arch Otorhinolaryngol. 2017;274(4):1781–1789. https://doi.org/10.1007/s00405-016-4338-1
7. Heimdal JH, Røksund OD, Halvorsen T, Skadberg BT, Olofsson J. Continuous laryngoscopy exercise test: a method for visualizing laryngeal dysfunction during exercise. Laryngoscope. 2006;116(1):52–57. https://doi.org/10.1097/01.mlg.0000184528.16229.ba
8. Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013;187(9):1016–1027. https://doi.org/10.1164/rccm.201303-0437ST
9. Halvorsen T, Walsted ES, Bucca C, Bush A, Cantarella G, Friedrich G, et al. Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement. Eur Respir J. 2017;50(3):1602221. https://doi.org/10.1183/13993003.02221-2016
10. Jansrud Hammer I, Halvorsen T, Vollsæter M, Hilland M, Røksund OD, Heimdal JH, et al. Conundrums in the breathless athlete; exercise-induced laryngeal obstruction or asthma? Scand J Med Sci Sports. 2022;32(6):1041–1049. https://doi.org/10.1111/sms.14137
11. Christensen PM, Heimdal JH, Christopher KL, Bucca C, Cantarella G, Friedrich G, et al. ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions. Eur Respir Rev. 2015;24(137):445–450. https://doi.org/10.1183/16000617.00006513
12. Johansson H, Norlander K, Berglund L, Janson C, Malinovschi A, Nordvall L, et al. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax. 2015;70(1):57–63. https://doi.org/10.1136/thoraxjnl-2014-205738
13. Ersson K, Mallmin E, Malinovschi A, Norlander K, Johansson H, Nordang L. Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes. Pediatr Pulmonol. 2020;55(12):3509–3516. https://doi.org/10.1002/ppul.25104
14. Irewall T, Bäcklund C, Nordang L, Ryding M, Stenfors N. High prevalence of exercise-induced laryngeal obstruction in a cohort of elite cross-country skiers. Med Sci Sports Exerc. 2021;53(6):1134–1141. https://doi.org/10.1249/MSS.0000000000002581
15. Bonini M, Palange P. Exercise-induced bronchoconstriction: new evidence in pathogenesis, diagnosis and treatment. Asthma Res Pract. 2015;1:2. https://doi.org/10.1186/s40733-015-0004-4
16. Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports. 2024;34(1):e14358. https://doi.org/10.1111/sms.14358
17. Černohorská A, Bednarczyk D, Białeta J, Garbarczyk W, Jurkiewicz M, Kapla A, et al. Exercise induced bronchoconstriction - an overview. Qual Sport. 2025;38:58304. https://doi.org/10.12775/QS.2025.38.58304
18. Barker N, Everard ML. Getting to grips with dysfunctional breathing. Paediatr Respir Rev. 2015;16(1):53–61. https://doi.org/10.1016/j.prrv.2014.10.001
19. Olin JT, Clary MS, Fan EM, Johnston KL, State CM, Strand M, et al. Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery. Eur Respir J. 2016;48(4):1192–1200. https://doi.org/10.1183/13993003.00160-2016
20. Giraud L, Destors M, Clin R, Fabre C, Doutreleau S, Atallah I. Diagnostic work-up of exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol. 2023;280(3):1273–1281. https://doi.org/10.1007/s00405-022-07654-7
21. Maat RC, Røksund OD, Halvorsen T, Skadberg BT, Olofsson J, Ellingsen TA, et al. Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations. Eur Arch Otorhinolaryngol. 2009;266(12):1929–1936. https://doi.org/10.1007/s00405-009-1030-8
22. Walsted ES, Hull JH, Hvedstrup J, Maat RC, Backer V. Validity and reliability of grade scoring in the diagnosis of exercise-induced laryngeal obstruction. ERJ Open Res. 2017;3(3):00070-2017. https://doi.org/10.1183/23120541.00070-2017
23. Carlsen PH, Muralitharan P, Fenne H, Hammer IJ, Engan M, Vollsæter M, et al. Laryngeal response to high-intensity exercise in healthy athletes. BMJ Open Sport Exerc Med. 2024;10(2):e001850. https://doi.org/10.1136/bmjsem-2023-001850
24. Johnston KL, Bradford H, Hodges H, Moore CM, Nauman E, Olin JT. The Olin EILOBI breathing techniques: description and initial case series of novel respiratory retraining strategies for athletes with exercise-induced laryngeal obstruction. J Voice. 2018;32(6):698–704. https://doi.org/10.1016/j.jvoice.2017.08.020
25. Fujiki RB, Olson-Greb B, Braden M, Thibeault SL. Therapy outcomes for teenage athletes with exercise-induced laryngeal obstruction. Am J Speech Lang Pathol. 2023;32(4):1517–1531. https://doi.org/10.1044/2023_AJSLP-22-00359
26. Karlsen T, Vreim K, Røksund OD, Vollsæter M, Muralitharan P, Ellingsen TA, et al. A speech therapy treatment protocol for exercise induced laryngeal obstruction. Front Pediatr. 2024;12:1356476. https://doi.org/10.3389/fped.2024.1356476
27. Vreim K, Karlsen T, Carlsen PH, Nistad VH, Røksund OD, Halvorsen T, et al. Speech therapy for exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol. 2025;282(3):1345–1354. https://doi.org/10.1007/s00405-024-09190-y
28. Strober WA, Rohlfing ML, Cutchin GM, Kallogjeri D, Piccirillo JF, Huston MN. Biofeedback vs respiratory retraining for inducible laryngeal obstruction: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2026;152(2):182–190. https://doi.org/10.1001/jamaoto.2025.4542
29. Sandnes A, Andersen T, Clemm HH, Hilland M, Vollsæter M, Heimdal JH, et al. Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training. BMJ Open Sport Exerc Med. 2019;5(1):e000436. https://doi.org/10.1136/bmjsem-2018-000436
30. Sandnes A, Andersen T, Clemm HH, Hilland M, Vollsæter M, Heimdal JH, et al. Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol. 2022;279(5):2511–2522. https://doi.org/10.1007/s00405-021-07214-5
31. Kolnes LJ, Stensrud T, Andersen OK. A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes. BMC Sports Sci Med Rehabil. 2024;16:13. https://doi.org/10.1186/s13102-023-00804-2
32. Siewers K, Backer V, Walsted ES. A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction. Laryngoscope Investig Otolaryngol. 2019;4(2):227–233. https://doi.org/10.1002/lio2.257
33. Sandnes A, Hilland M, Vollsæter M, Andersen T, Engesæter IØ, Sandvik L, et al. Severe exercise-induced laryngeal obstruction treated with supraglottoplasty. Front Surg. 2019;6:44. https://doi.org/10.3389/fsurg.2019.00044
34. Irewall T, Bäcklund C, Naumburg E, Ryding M, Stenfors N. A longitudinal follow-up of continuous laryngoscopy during exercise test scores in athletes irrespective of laryngeal obstruction, respiratory symptoms, and intervention. BMC Sports Sci Med Rehabil. 2023;15:87. https://doi.org/10.1186/s13102-023-00681-9
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Natalia Kasterka, Magdalena Kolasa, Liwia Karbownik, Agnieszka Figwer, Krzysztof Figwer, Kinga Dzitkowska, Norbert Czarny, Anna Broniecka, Michał Śmigielski, Jędrzej Garbaciak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 68
Number of citations: 0
