Exercise-Induced Laryngeal Obstruction (EILO) Mimicking Asthma in Athletes: A Comprehensive Clinical Review
DOI:
https://doi.org/10.12775/QS.2026.63.73155Keywords
EILO, exercise-induced laryngeal obstruction, bronchial asthma, differential diagnosis, exertional dyspnea, CLE test, respiratory retraining, sports medicineAbstract
Background. Exercise-Induced Laryngeal Obstruction (EILO) is a significant yet frequently misdiagnosed cause of respiratory distress in athletes. Due to symptomatic overlap, it is routinely mistaken for bronchial asthma or exercise-induced bronchoconstriction (EIB). This diagnostic confusion leads to ineffective pharmacological treatment and impaired athletic performance.
Aim. The aim of this review is to evaluate the clinical relationship between EILO and asthma, focusing on the physiological differences, diagnostic imperatives, and management strategies in competitive sports.
Material and Methods. A comprehensive search of electronic databases, including PubMed, ScienceDirect, and Google Scholar, was conducted. The search strategy involved keywords such as "EILO", "exercise-induced laryngeal obstruction", "laryngeal obstruction", "asthma", and "CLE test". The analysis focused on peer-reviewed clinical trials and consensus statements. Sources were selected based on their relevance to pathophysiology, diagnostic accuracy, and therapeutic efficacy in the athletic population.
Results. The study demonstrates that while EIB involves inflammatory narrowing of the lower airways, EILO is a mechanical event at the laryngeal level driven by Bernoulli’s principle. Differentiation depends on the timing of symptoms: EILO occurs during peak effort, whereas EIB typically presents post-exercise. The Continuous Laryngoscopy Exercise (CLE) test is confirmed as the gold standard for real-time visualization. Management is predominantly non-pharmacological, with respiratory retraining and biofeedback showing high efficacy.
Conclusions. EILO should be considered a primary differential diagnosis in athletes unresponsive to asthma therapy. Objective endoscopic evaluation is essential to prevent medical errors. A multidisciplinary approach, prioritizing respiratory physiotherapy over pharmacology, is necessary to restore optimal breathing patterns and performance.
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Copyright (c) 2026 Aleksandra Banasik, Gabriela Fryszer, Gabriela Afrykańska, Bernard Pomykała, Oliwia Mirkowska, Zuzanna Leciej, Michał Lubkowski, Krzysztof Orzeł, Hubert Skwarna, Kinga Anna Krzysztofik
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