Inducible laryngeal obstruction/vocal cord obstruction: still happening under our noses

Inducible laryngeal obstruction (ILO) is an enigmatic condition with considerable impact on clinical practice. Historically, this condition has been known by several names, most notably vocal cord dysfunction (VCD) coined by Christopher and colleagues in 1983.1 However, it has been proposed to replace this terminology by the umbrella term ‘ILO’ and the term ILO will therefore be used throughout the manuscript. The prevalence of ILO in a general population has not been reported. However, it often acts as an asthma mimic, with a pooled prevalence in adults with asthma of approximately 25%.2 Progress in chronic cough3 and severe asthma has reignited interest in ILO as a key treatable trait that could be impeding remission and contributing to ‘difficult-to-treat asthma’.4 Approximately 10 years ago, we published a paper in Thorax entitled: ‘Middle airway obstruction: it is happening under our noses’ to draw attention to this disorder.5 Substantial progress has been made (box 1); however, several key gaps remain. Box 1 ### Recent progress and future challenges in ILO #### Progress #### Challenges