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Exercise-induced laryngeal obstruction in children and adolescents: are we listening?
  1. Liam Welsh1,2,
  2. Alessandra Giannini3,
  3. John Massie1,2,4
  1. 1 Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. 3 Melbourne Allergy Centre and Children's Specialists, Melbourne, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Liam Welsh, Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; liam.welsh{at}


Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered ‘rare’ though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.

  • adolescent health
  • pharmacology

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  • Contributors All authors jointly contributed to the development and production of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Further information is available on the online supplement.