Dr. Tod Olin teaches breathing exercises to Alexis Beggar, who has exercise-induced laryngeal obstruction (EILO). Courtesy of National Jewish Health.
With less than a month to go until the 2018 Winter Olympics, competitors are intensifying their training regimens.
Whether at an elite or amateur level, many athletes know how it feels to push their bodies to the limit. But for those living with a breathing disorder known as exercise-induced laryngeal obstruction (EILO), it can be much more difficult.
The ailment has been described by some as trying to breathe through a straw. In many cases, people with this vocal cord disorder are mistakenly given an asthma diagnosis.
Asthma medications are ineffective for treating EILO, which can affect anyone from weekend athletes to professional Olympians.
Now, new breathing techniques are helping athletes continue their training by managing their symptoms when they strike.
“In layman’s terms, EILO is a condition in which the vocal cords and surrounding structures obstruct the airway during high-intensity exercise. It is generally speaking not dangerous. It almost never causes changes in oxygen levels, but it can dramatically impair a patient’s ability to exercise comfortably and efficiently,” Dr. Tod Olin, a pediatric pulmonologist at National Jewish Health, told Healthline.
It’s not asthma
EILO can emerge during strenuous exercise and can cause wheezing, coughing, and a feeling of breathlessness.
The feeling of suffocation that can occur can be distressing. It can also cause feelings of dizziness.
Athletes with EILO can feel limited in how hard they can push themselves when training and competing.
“In terms of impact on sport performance, it likely causes a severe increase in the quantity of energy it takes to breathe. It is also very frightening for most patients. These two factors will lead to a decrease in efficiency of movements as well as a conscious or unconscious choice to back off… in an attempt to improve the breathing in many cases,” Olin said.
Although EILO was identified in the 1980s, experts say the condition is still widely misunderstood. Olin says doctors are often too quick to conclude that a patient has asthma, not EILO.
“Healthcare providers unconsciously play a game of probability in every conversation. Asthma is usually the first guess regarding diagnosis in a quick conversation about shortness of breath during exercise,” he said.
Dr. James Hull, a consultant respiratory physician at Royal Brompton Hospital in London and an expert on EILO, says a misdiagnosis of asthma is a common problem.
“When young people report a ‘wheezing sound’ and breathlessness on exertion, the most immediate thought from a GP is that this is likely to be asthma. The problem with the misdiagnosis is that it usually means athletes don’t get the most effective treatment targeting EILO, and they are also exposed to risks and side effects of unnecessary asthma medications,” he told Healthline.
“It is present in between 5 to 10 percent of the whole adolescent population, and yet nearly everyone I speak to about this condition has never heard of it,” he added.
Exercises that can help
When EILO was first discovered, experts developed a series of breathing techniques to help people with the condition.
These are still helpful for many people with EILO.
The problem with the old techniques, Olin says, is that they can’t be performed during high-intensity exercise, which can often be when symptoms strike.
Trying to inhale through the nose while sprinting, for example, isn’t easy for many athletes.
Olin developed new breathing exercises after observing the airways of patients during intense exercise. In a study, he asked patients to pedal as fast as they could on an exercise bike, while a camera took pictures of their vocal cords. The cords of those with EILO tightened and closed near the top of the airway, causing difficulty breathing.
“We found that if EILO patients can control and change the airflow through their mouth, they’re also able to control their throat,” Olin said.
“After teaching them these new techniques, 80 percent of patients reported them to be extremely helpful, and two-thirds of patients were able to control their EILO symptoms by using them during exercise,” he explained.
The new techniques are difficult to learn, but Olin says with proper instruction and practice, the majority of patients see an improvement.
Both Olin and Hull recommend people who fear they may have been given a misdiagnosis of asthma rather than EILO to record a video of their wheezing episode and show this to a primary care physician.
“EILO is often visually fairly apparent, and we can see some of the characteristic struggles and hear some of the characteristic sounds on videos. Healthcare providers may be able to distinguish EILO from the videos in a way that a conversation could not,” Olin said.
If you find yourself with a diagnosis of EILO, experts say there’s no reason to stop training, either at an amateur or elite level.
“You can still do well with EILO, and we have treated a great number of very elite Olympic athletes who have progressed to do well despite having a diagnosis of EILO,” Hull said.