School-age athletes to elite skiers sometimes struggle with exercise-induced laryngeal obstruction, or EILO, which causes breathing problems, wheezing, and other symptoms during exertion.

Too often, however, an EILO diagnosis is missed or delayed, because it’s mistaken for asthma or there’s not enough general awareness of the condition. That’s according to Dr. Edouard Sayad and Dr. Shailendra Das from Baylor College of Medicine, who explored EILO and its diagnosis in StatPearls, a medical database of peer-reviewed articles.

One conclusion they reach is the importance of collaboration among healthcare practitioners to best evaluate and manage the condition — an “interprofessional team approach” featuring pulmonologists on the front line, otolaryngologists evaluating the upper airway, speech and language pathologists managing the condition, and others.

These breathing problems are the result of a narrowing or inappropriate obstruction of the vocal fold or supraglottic structures in response to a trigger or stimulus. EILO is particularly common among teens and adolescents and predominantly affects female athletes. Symptoms can also include throat and chest tightness and anxiety.

The “gold standard” for diagnosing EILO, they write, is visualizing the larynx using flexible laryngoscopy during symptomatic periods. A new approach is continuous laryngoscopy during exercise on a treadmill or stationary bicycle.

Teens are not the only athletes challenged by these breathing problems. EILO is also common among other athletes, including elite cross-country skiers, according to Dr. Tommie Irewall and others in research published in Med Sci Sports Exercise.

In that Swedish study of 89 cross-country skiers, 27 percent were identified as having EILO. Of those with EILO, 83 percent were female, research by Dr. Irewall and his team found.

And specialists at Liverpool and Chest Hospital, which is the largest single-site specialist heart and chest hospital in the U.K., needed a lightweight, flexible endoscope with good image quality to identify laryngeal obstruction during exercise for a new line of care they were opening. They chose the Ambu aScope 4 RhinoLaryngo to diagnose patients.

Single-use flexible endoscopes made it easier for ENTs to observe the symptoms as they happened in real time, helping them make a correct diagnosis.

Testing is done by attaching a flexible laryngoscope to the patient’s head. The tip of the scope is introduced through the nose into the larynx, enabling visualization of the supraglottic and glottic structures in real time during the exercise.

Continuous laryngoscopy during exercise has been adopted as the test of choice for EILO diagnosis by the European Respiratory Society and European Laryngological Society.