Exercise-Induced Laryngeal Obstruction and Asthma in Athletes: A Narrative Review of Diagnostic Pitfalls, Comorbidities, Psychological Impact, and Management

Background: Exertional dyspnea in athletes is most commonly attributed to exercise-induced bronchoconstriction (EIB), leading to frequent diagnostic errors and the overuse of inhaled medications. However, increasing evidence indicates that exercise-induced laryngeal obstruction (EILO) is a frequent and significant cause of these symptoms that is often overlooked in sports medicine. Aim: This study aims to provide a comprehensive review of the diagnostic challenges associated with EILO, specifically focusing on its differentiation from EIB, the impact of comorbidities, the psychological burden on athletes, and modern therapeutic strategies. Material and methods: A narrative literature review was conducted using PubMed, Scopus, and Google Scholar databases, covering the period from 2016 to 2026. The analysis included original research articles, systematic reviews, and current consensus statements from international sports medicine and laryngology societies. Results: EILO involves the paradoxical collapse of laryngeal structures during inspiration. It is clinically differentiated from asthma by the presence of inspiratory stridor, an immediate resolution of symptoms upon the cessation of exercise, and a lack of response to bronchodilators. The review highlights that over half of EILO patients suffer from coexisting laryngopharyngeal reflux, and untreated upper respiratory allergies further lower the laryngeal trigger threshold. Furthermore, the sudden onset of dyspnea frequently triggers a "panic-breathlessness cycle," which exacerbates laryngeal spasms and reduces the athlete's quality of life. The continuous laryngoscopy during exercise (CLE) test remains the diagnostic gold standard. Proper recognition allows for the avoidance of unnecessary pharmacotherapy in favor of targeted non-pharmacological treatments, primarily specialized respiratory physiotherapy. Conclusions: EILO is a frequent, often overlooked cause of exertional dyspnea in athletes. Accurate differentiation from EIB through identification of inspiratory stridor, rapid symptom resolution, and bronchodilator non-response is essential. Proper management requires CLE-based diagnosis, targeted respiratory physiotherapy, and concurrent treatment of comorbidities, while addressing psychological factors significantly improves athletes' quality of life.