Ludovic Giraud1,2, Marie Destors3, Rita Clin3,4,5, Christol Fabre1,2, Stéphane Doutreleau6, Ihab Atallah7,8. 1. Otolaryngology-Head and Neck Surgery Department, Clinique Universitaire d'ORL et Chirurgie Cervico-Faciale, CHU Grenoble Alpes, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France. 2. Faculté́ de Médecine, Université́ Grenoble Alpes, Domaine de la Merci, BP 170, 38042, Grenoble Cedex 9, France. 3. Clinique de Physiologie Sommeil et Exercice, CHU Grenoble Alpes, BP 217, 38043, Grenoble Cedex 09, France. 4. Inserm 1042, Laboratoire HP2, Université Grenoble-Alpes, 38000, Grenoble, France. 5. Pôle Thorax et Vaisseaux, Clinique de Physiologie Sommeil et Exercice, CHU de Grenoble-Alpes, 38000, Grenobl, France. 6. Médecine du Sport, CHU Grenoble Alpes, Hôpital Sud, 19 Avenue de Kimberley, 38130, Échirolles, France. 7. Otolaryngology-Head and Neck Surgery Department, Clinique Universitaire d'ORL et Chirurgie Cervico-Faciale, CHU Grenoble Alpes, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France. iatallah@chu-grenoble.fr. 8. Faculté́ de Médecine, Université́ Grenoble Alpes, Domaine de la Merci, BP 170, 38042, Grenoble Cedex 9, France. iatallah@chu-grenoble.fr.
Abstract
PURPOSE: Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs). METHODS: All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard. RESULTS: Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively. CONCLUSIONS: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management.
PURPOSE: Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs). METHODS: All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard. RESULTS: Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively. CONCLUSIONS: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management.
Authors: Pernille M Christensen; John-Helge Heimdal; Kent L Christopher; Caterina Bucca; Giovanna Cantarella; Gerhard Friedrich; Thomas Halvorsen; Felix Herth; Harald Jung; Michael J Morris; Marc Remacle; Niels Rasmussen; Janet A Wilson Journal: Eur Respir Rev Date: 2015-09
Authors: Henrik Johansson; Katarina Norlander; Lars Berglund; Christer Janson; Andrei Malinovschi; Lennart Nordvall; Leif Nordang; Margareta Emtner Journal: Thorax Date: 2014-11-07 Impact factor: 9.139
Authors: Robert Christiaan Maat; Ola D Røksund; Thomas Halvorsen; Britt T Skadberg; Jan Olofsson; Thor A Ellingsen; Hans J Aarstad; John-Helge Heimdal Journal: Eur Arch Otorhinolaryngol Date: 2009-07-08 Impact factor: 2.503