Bronchial provocation testing does not detect exercise-induced laryngeal obstruction
- 26 September 2016
- journal article
- exercise
- Published by Taylor & Francis Ltd in Journal of Asthma
- Vol. 54 (1), 77-83
- https://doi.org/10.1080/02770903.2016.1195843
Abstract
Introduction: Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for asthma in the presence of exertional respiratory symptoms. Continuous laryngoscopy during exercise (CLE), the current gold standard diagnostic test for EILO, has practical limitations. We aimed to establish if inspiratory flow data obtained during standard bronchoprovocation testing, to establish the presence of extra-thoracic hyper-responsiveness, may prove diagnostic for EILO and thus preclude requirement for CLE testing. Methods: We consecutively evaluated 37 adult subjects with exertional dyspnea and possible asthma referred over 6 months. All subjects received comprehensive assessment including a detailed clinical evaluation; pulmonary function testing, indirect and direct bronchial provocation testing, and CLE testing. Results: Out of 37 subjects, moderate or severe EILO was diagnosed in 8 subjects (22%, all female) while 5 (14%) had both asthma and EILO. There was no correlation between degree of EILO during CLE and mean decrease in forced inspiratory flow (%FIF50) obtained during neither the Methacholine (r = −0.15; p = 0.38) nor Mannitol (r = 0.04; p = 0.84) provocation tests. Conclusion: Inspiratory flow parameters obtained during bronchoprovocation tests did not reliably detect EILO. It remains that CLE is an important and key investigation modality in establishing a secure diagnosis of EILO.Keywords
This publication has 26 references indexed in Scilit:
- Can flow-volume loops be used to diagnose exercise-induced laryngeal obstructions? A comparison study examining the accuracy and inter-rater agreement of flow-volume loops as a diagnostic toolPrimary Care Respiratory Journal, 2013
- Laryngeal sensory dysfunction in laryngeal hypersensitivity syndromeRespirology, 2013
- Managing respiratory problems in athletesClinical Medicine, 2012
- Exercise-induced laryngeal obstruction: natural history and effect of surgical treatmentEuropean Archives of Oto-Rhino-Laryngology, 2011
- Chronic cough and irritable larynxJournal of Allergy and Clinical Immunology, 2011
- Exhaled Nitric Oxide in Pulmonary Diseases: A Comprehensive ReviewSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2010
- Global strategy for asthma management and prevention: GINA executive summaryEuropean Respiratory Journal, 2008
- Continuous Laryngoscopy Exercise Test: A Method for Visualizing Laryngeal Dysfunction during ExerciseThe Laryngoscope, 2006
- Vocal cord dysfunction and laryngeal hyperresponsiveness: a function of altered autonomic balance?Thorax, 2002
- Results of biological standardization with standardized allergen preparationsAllergy, 1987