When doing high-intensity exercise, have you ever experienced shortness of breath, chest tightness, or wheezing? It may feel scary at the time, as though you can’t breathe. Two conditions could be the culprit: exercise-induced laryngeal obstruction (EILO) or exercise-induced asthma.
EILO is a less common condition that causes similar symptoms to exercise-induced asthma. But EILO won’t respond to the same treatments. That’s why it’s important to understand the difference and get a correct diagnosis.
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What Is EILO?
When you do strenuous exercise, you begin to take deeper breaths. Normally, when you breathe heavily, your larynx (upper airway) opens. That lets you take deeper breaths. But when you have EILO, your larynx narrows or closes altogether, making it hard to take a full breath.
EILO causes shortness of breath, noisy breathing, especially when breathing in, and throat tightness. However, these feelings come on quickly and only last during exercise. They resolve right away when you stop.
About 5% to 7% of people have EILO. It’s common in athletes and is more likely to affect girls than boys.
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What Is Exercise-Induced Asthma?
This condition is also called exercise-induced bronchoconstriction (EIB), which is different from chronic asthma. Chronic asthma symptoms can be triggered by a variety of factors including allergies. Those triggers cause the airways in your lungs to become intermittently inflamed and narrowed, making breathing difficult.
In exercise-induced asthma, or EIB, the air passages in your lungs tighten as a result of intense exercise. That makes it hard for you to breathe. You may have shortness of breath, wheezing, and coughing that are similar to EILO. EIB is much more common in people who already have chronic asthma. However, even people who don’t have asthma can experience EIB.
One difference between EILO and EIB is that symptoms of EIB can worsen for 10 to 20 minutes after you stop exercising. Cold, dry air, pollution, and other environmental factors can trigger EIB. However, EILO occurs during exercise without other factors triggering symptoms. Up to 30% of patients with exercise-induced asthma may also have EILO.
How Are the Conditions Diagnosed and Treated?
Treatments differ between the two conditions, which is why having an accurate diagnosis is so important. EILO does not respond to medications. However, medications and inhalers commonly used for asthma can be used to treat EIB.
EILO symptoms only occur during exercise, so a doctor needs to monitor you during exercise to make a diagnosis. He or she will use a camera to view your upper airway as you do intense exercise, such as running on a treadmill or riding a stationary bike. This test is called a continuous laryngoscopy evaluation (CLE). By seeing if the upper airway narrows, your doctor can make an accurate diagnosis. Your doctor may also perform other tests, such as a spirometry (lung function test) or inhalational (methacholine) challenge test, to rule out underlying asthma.
It is possible to have asthma and EILO. But EILO is a different condition, affecting a different part of your airway than asthma. Asthma affects the lower airway, whereas EILO affects the upper airway. Asthma symptoms should resolve with bronchodilators or inhaled steroids. You may want to talk to a specialist if you are being treated for EIB but still have symptoms during exercise. Treatment for EILO involves breathing exercises to train your upper airway to stay open and modify your respiratory rate during exercise.
Having difficulty breathing when you exercise is scary. It may make you reluctant to exercise, or it may make it harder for you to reach your peak athletic performance. It’s always good to talk to a doctor if you have trouble breathing when exercising. Your doctor may refer you to a specialist — often a pulmonologist, an ear, nose, and throat (ENT) doctor, or a cardiologist — for testing and treatment.
UPMC Experts Can Help
Getting the right tests are the first steps toward an accurate diagnosis. Understanding the differences between the two conditions can help you get treated and back in motion faster.
For more information about EIB and asthma or to schedule an appointment, contact the University of Pittsburgh Asthma Institute at UPMC at 412-648-6161.
For more information about EILO, including diagnostic testing performed by our allergy, pulmonology, and ENT experts, contact the Upper Airway Breathing Center at UPMC at 412-648-6161.
Asthma and Allergy Foundation of America. Exercise-induced asthma. https://www.aafa.org/exercise-induced-asthma/
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