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Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction.

  • Walsted, Emil S1, 2
  • Faisal, Azmy1, 3, 4
  • Jolley, Caroline J5
  • Swanton, Laura L1
  • Pavitt, Matthew J1
  • Luo, Yuan-Ming6
  • Backer, Vibeke2
  • Polkey, Michael I1, 7
  • Hull, James H1, 7
  • 1 Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom. , (United Kingdom)
  • 2 Respiratory Research Unit, Bispebjerg Hospital , Copenhagen , Denmark. , (Denmark)
  • 3 Faculty of Physical Education for Men, Alexandria University , Alexandria , Egypt. , (Egypt)
  • 4 School of Health, Sport and Bioscience, University of East London , London , United Kingdom. , (United Kingdom)
  • 5 King's College London, Centre of Human and Aerospace Physiological Sciences, King's Health Partners, London , United Kingdom. , (United Kingdom)
  • 6 Guangzhou Medical College, National Key Laboratory of Respiratory Disease , Guangzhou , People's Republic of China. , (China)
  • 7 National Heart and Lung Institute, Imperial College London , London , United Kingdom. , (United Kingdom)
Published Article
Journal of Applied Physiology
American Physiological Society
Publication Date
Feb 01, 2018
DOI: 10.1152/japplphysiol.00691.2017
PMID: 29097629


Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V̇e) (work rate: 227 ± 35 vs. 237 ± 35 W; V̇e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing ( P < 0.05) and respiratory neural drive ( P < 0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure ( P < 0.05). Unexpectedly, a ventilatory increase ( P < 0.05), driven by augmented tidal volume ( P < 0.05), was seen in subjects with EILO before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an augmented tidal volume and a rise in minute ventilation.

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