Page 70 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 70
problems in patients with certain psychiatric between the two vocal processes of the aryte-
disorders (e.g. depression, childhood sexu- noid cartilages9,12.
severe asthma forum 1: severe asthma - basic and clinical views al abuse, obsessive-compulsive disorders)16,4.
Women predominate among ELO patients, Diagnostic Procedures
with a 3:1 ratio in their favour as reported
in the professional literature. Problems most A group of different specialists should be in-
commonly occur between the ages of 20 and volved in the diagnostics of ELO (otorhi-
40, but patients aged 6 to 83 years have also nolaryngologist, pulmonologist, gastroenter-
been described9,23. ologist, neurologist, psychiatrist, psychologist,
speech therapist and others according to the
More information is available for EILO, clinical picture). The gold standard in ELO
one of the subtypes of ELO. EILO occurs diagnostics is a larynx examination using a
mostly in adolescent or young adult wom- flexible nasolaryngoscope during the attack
en, often top athletes at maximum exercise. of dyspnea. In most cases it is impossible to
Among randomly selected young people in have the opportunity to perform the exami-
Denmark, at least 7.5% of people with EILO nation and to have the necessary equipment
were identified, and among adolescents with on site. Only in EILO, the diagnostic proce-
upper respiratory hyperexcitability, as many dure can be planned and carried out. Flexible
as 26.1% of people with EILO42,8. nasolaryngoscopy is performed during exer-
cise on a bicycle or treadmill while monitor-
Symptoms and Signs ing ECG, lung function, blood oxygen satura-
tion, and blood pressure fluctuations21,48,40. At
Especially in EILO, shortness of breath oc- rest or in the period without problems, the la-
curs and very often also inspiratory stridor ryngoscopic picture is usually normal.
during physical exertion, so these patients
are initially treated for exercise-induced asth- In the differential diagnosis of ELO,
ma33,43. Other symptoms include dysphonia, asthma, especially stress-induced asthma,
dysphagia, cough, and some patients also re- anaphylactic and other allergic reactions, for-
port a foreign body sensation in the throat eign body in the respiratory tract, angioede-
or a feeling of discomfort in the chest and ma, laryngospasm, epiglottitis, other upper
throat9. Problems can occur at rest or dur- respiratory infections, unilateral and bilater-
ing physical exertion, either during the day al paralysis of the larynx from other causes,
or at night. Symptoms of shortness of breath adductor-respiratory congenital anomalies
and inspiratory stridor can be triggered by an and benign and malignant changes in the lar-
identified trigger (e.g. strong odour, irritants ynx, stenosis of the larynx and upper trachea
in the air, emotional stress), or they can occur must be mentioned. To exclude other diseas-
without any obvious reason. Problems usual- es that can also cause occasional breathing
ly pass within seconds, minutes rarely lasting problems and audible breathing, it is advis-
longer32. Occlusion at the level of the supra- able to take a measurement of lung function.
glottis occurs more frequently. The arytenoids The flow-volume curve shows a typical de-
descend forward above the entrance to the crease in the curve during inspiration dur-
larynx, the aryepiglottic folds approach the ing an ELO attack. A methacholine test is
median line, leaving little room for breathing required to rule out asthma. Positive aller-
between them and the epiglottis. In the case of gy tests, detection of peripheral blood eosin-
glottis closure, the vocal folds come very close ophils, C1 inhibitor concentrations, and C4
together, they can even be practically com- levels distinguish ELO from allergic mani-
pressed, leaving only a tiny space for breathing festations and angioedema9. It is possible that
exercise-induced asthma and EILO coexist.
disorders (e.g. depression, childhood sexu- noid cartilages9,12.
severe asthma forum 1: severe asthma - basic and clinical views al abuse, obsessive-compulsive disorders)16,4.
Women predominate among ELO patients, Diagnostic Procedures
with a 3:1 ratio in their favour as reported
in the professional literature. Problems most A group of different specialists should be in-
commonly occur between the ages of 20 and volved in the diagnostics of ELO (otorhi-
40, but patients aged 6 to 83 years have also nolaryngologist, pulmonologist, gastroenter-
been described9,23. ologist, neurologist, psychiatrist, psychologist,
speech therapist and others according to the
More information is available for EILO, clinical picture). The gold standard in ELO
one of the subtypes of ELO. EILO occurs diagnostics is a larynx examination using a
mostly in adolescent or young adult wom- flexible nasolaryngoscope during the attack
en, often top athletes at maximum exercise. of dyspnea. In most cases it is impossible to
Among randomly selected young people in have the opportunity to perform the exami-
Denmark, at least 7.5% of people with EILO nation and to have the necessary equipment
were identified, and among adolescents with on site. Only in EILO, the diagnostic proce-
upper respiratory hyperexcitability, as many dure can be planned and carried out. Flexible
as 26.1% of people with EILO42,8. nasolaryngoscopy is performed during exer-
cise on a bicycle or treadmill while monitor-
Symptoms and Signs ing ECG, lung function, blood oxygen satura-
tion, and blood pressure fluctuations21,48,40. At
Especially in EILO, shortness of breath oc- rest or in the period without problems, the la-
curs and very often also inspiratory stridor ryngoscopic picture is usually normal.
during physical exertion, so these patients
are initially treated for exercise-induced asth- In the differential diagnosis of ELO,
ma33,43. Other symptoms include dysphonia, asthma, especially stress-induced asthma,
dysphagia, cough, and some patients also re- anaphylactic and other allergic reactions, for-
port a foreign body sensation in the throat eign body in the respiratory tract, angioede-
or a feeling of discomfort in the chest and ma, laryngospasm, epiglottitis, other upper
throat9. Problems can occur at rest or dur- respiratory infections, unilateral and bilater-
ing physical exertion, either during the day al paralysis of the larynx from other causes,
or at night. Symptoms of shortness of breath adductor-respiratory congenital anomalies
and inspiratory stridor can be triggered by an and benign and malignant changes in the lar-
identified trigger (e.g. strong odour, irritants ynx, stenosis of the larynx and upper trachea
in the air, emotional stress), or they can occur must be mentioned. To exclude other diseas-
without any obvious reason. Problems usual- es that can also cause occasional breathing
ly pass within seconds, minutes rarely lasting problems and audible breathing, it is advis-
longer32. Occlusion at the level of the supra- able to take a measurement of lung function.
glottis occurs more frequently. The arytenoids The flow-volume curve shows a typical de-
descend forward above the entrance to the crease in the curve during inspiration dur-
larynx, the aryepiglottic folds approach the ing an ELO attack. A methacholine test is
median line, leaving little room for breathing required to rule out asthma. Positive aller-
between them and the epiglottis. In the case of gy tests, detection of peripheral blood eosin-
glottis closure, the vocal folds come very close ophils, C1 inhibitor concentrations, and C4
together, they can even be practically com- levels distinguish ELO from allergic mani-
pressed, leaving only a tiny space for breathing festations and angioedema9. It is possible that
exercise-induced asthma and EILO coexist.
