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Upper Airway Exercise Breathing Center at UPMC

Do you have trouble breathing during high-intensity exercise? If so, you might have exercise-induced laryngeal obstruction (EILO). The Upper Airway Breathing Center at UPMC's Comprehensive Lung Center can help.

Our expert care team provides detailed exams, diagnoses, and treatments for people with EILO.

What Is EILO?

As you exercise and start to breathe heavily, your upper airway — called the larynx — should widen. This lets you breathe in more air.

When you have EILO, the larynx narrows instead. This means you're not able to breathe as deeply. And since the larynx is narrow, you may take loud, gasping breaths.

EILO differs from exercise-induced asthma, which requires a different treatment approach.

The two conditions can look alike or even occur together. So, having a precise diagnosis is key to finding relief and regaining confidence in your athletic performance.

Who's at Risk for EILO?

This condition affects:

  • About 5% to 7% of people in the U.S.
  • Mostly athletes, including weekend warriors and amateur athletes, in their teens and young adulthood.
  • Older adults.
  • Girls more than boys.

EILO Symptoms

Symptoms of EILO occur suddenly during exercise and go away within a few minutes after you stop.

Signs to look for include:

  • Shortness of breath
  • Noisy breathing (wheezing, gasping, rasping)
  • Tightness in the throat or chest
  • Feeling of choking

EILO isn't life-threatening, but it can be scary when you feel as if you're choking.

Left untreated, it can lead to stress and anxiety, limiting your enjoyment of sports or workouts. The good news is that EILO treatment is simple and highly successful.

When to See a Doctor for EILO

The Upper Airway Exercise Breathing Center has a team solely focused on diagnosing and treating EILO.

We offer complete diagnostics and care to help you get better.

You should think about making an appointment with our center if you:

  • Have unexplained shortness of breath or wheezing when doing high-intensity exercise.
  • Have a history of exercise-induced asthma or other breathing problems that standard treatment hasn't helped.

It's common to mistake EILO for asthma, which leads to the needless use of drugs. Inhaled steroids don't work for EILO.

EILO is also like vocal cord dysfunction (VCD) or paradoxical vocal fold disorder, but exercise doesn't cause VCD.

VCD causes include acid reflux or exposure to:

  • Certain scents
  • Stress
  • Infections
  • Pollutants
  • Other triggers

At UPMC, we perform an in-depth assessment to find the cause of your breathing problems and make a proper diagnosis. We'll look for EILO and other upper airway conditions that cause trouble breathing.

And, since EILO and asthma do sometimes occur together, we can design a treatment plan for both conditions.

EILO Diagnosis

The gold standard for diagnosing EILO is by continuous laryngoscopy evaluation (CLE) with exercise.

Symptoms of EILO only occur at the peak of exercise and fade quickly. CLE lets your doctor assess your breathing while you work out.

Before any testing, your doctor may ask you to stop taking asthma medicine to improve the accuracy of your results.

What to Expect During CLE Testing

CLE uses a small camera to provide a nonstop look at your upper airway during exercise.

Your doctor will insert the tiny camera through your nose and into the throat to record how your larynx responds during exercise.

You'll wear a headgear that holds the camera in place while you work out, often running on a treadmill.

To diagnose or rule out other breathing problems, your care team may also order more imaging tests, such as:

  • Spirometry. To measure your lung function.
  • Methacholine challenge test. To look for asthma or VCD, which can also cause breathing issues.
  • Exhaled nitric oxide. To look for asthma.
  • Continuous laryngoscopy with provocation. To test for VCD, a condition much like EILO, but caused by environmental triggers such as scent.
  • Cardiopulmonary exercise testing with CLE. To check your upper airway, as well as heart, lungs, and musculoskeletal system.

Your safety is the foremost concern of our care team. We'll keep a close eye on you throughout all tests. And, if you have any distress, we'll stop right away.

Testing can last up to several hours, based on the tests you need.

You'll receive your test results and diagnosis right away, and our care team will work with you to decide the next steps. If you have EILO and another breathing disorder, we'll connect you with the right specialists at UPMC.

UPMC accepts most major insurance, which often covers testing. You may need prior approval for coverage, so be sure to check with your health plan before making your appointment.

EILO Treatment

Treatment for EILO at the Upper Airway Exercise Breathing Center involves learning breathing techniques.

A speech-language pathologist will teach you ways to help keep your airway open during exercise. You'll have two to four sessions, each lasting 30 to 45 minutes.

In some cases, a sports psychologist may also provide respiratory retraining.

Treatment is typically successful in helping people overcome their breathing problems and be active again.

After you complete treatment, you may need another CLE to make sure the upper airway widens during exercise.

Our Experts

A team of allergy, respiratory, and ear, nose and throat experts work together to perform diagnostic CLE tests. If they determine you have EILO, they will develop a treatment plan to address your needs.

Andrej A. Petrov, MD
Dr. Petrov is is an allergist-immunologist in the UPMC Division of Pulmonary, Allergy and Critical Care Medicine.

Jackie Gartner-Schmidt, PhD, CCC-SLP

Dr. Gartner-Schmidt is a dyspnea-specialized speech-language pathologist and director of the Speech-Language Pathology-Voice Division in the UPMC Department of Otolaryngology and co-director of the UPMC Voice Center.

Why Choose UPMC for EILO Care?

UPMC is only the second medical center in the country to offer CLE. This test is the best way to diagnose EILO. With a precise diagnosis, you can be sure you're getting the proper treatment. You have access to the extensive expertise of the team at the Upper Airway Exercise Breathing Center, including allergy, respiratory, and ear, nose, and throat specialists.

The Upper Airway Exercise Breathing Center is at the UPMC Comprehensive Lung Center in Pittsburgh.

To make an appointment with one of our experts, call 412-648-6161 or request an appointment online.

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