High prevalence of exercise-induced stridor during Parkrun: a cross-sectional field-based evaluation.

BACKGROUND AND OBJECTIVE: The differential diagnosis for exercise-associated breathlessness is broad, however, when a young athletic individual presents with respiratory symptoms, they are most often prescribed inhaler therapy for presumed exercise-induced asthma (EIA). The purpose of this study was therefore to use a novel sound-based approach to assessment to evaluate the prevalence of exertional respiratory symptoms and characterise abnormal breathing sounds in a large cohort of recreationally active individuals. METHODS: Cross-sectional field-based evaluation of individuals completing Parkrun. PHASE 1: Prerace, clinical assessment and baseline spirometry were conducted. At peak exercise and immediately postrace, breathing was monitored continuously using a smartphone. Recordings were analysed retrospectively and coded for signs of the predominant respiratory noise. PHASE 2: A subpopulation that reported symptoms with at least one audible sign of respiratory dysfunction was randomly selected and invited to attend the laboratory on a separate occasion to undergo objective clinical workup to confirm or refute EIA. RESULTS: Forty-eight participants (22.6%) had at least one audible sign of respiratory dysfunction; inspiratory stridor (9.9%), expiratory wheeze (3.3%), combined stridor+wheeze (3.3%), cough (6.1%). Over one-third of the cohort (38.2%) were classified as symptomatic. Ten individuals attended a follow-up appointment, however, only one had objective evidence of EIA. CONCLUSIONS: The most common audible sign, detected in approximately 1 in 10 individuals, was inspiratory stridor, a characteristic feature of upper airway closure occurring during exercise. Further work is now required to further validate the precision and feasibility of this diagnostic approach in cohorts reporting exertional breathing difficulty

Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs

Quantification and analysis of laryngeal closure from endoscopic videos

Objective: At present, there are no objective techniques to quantify and describe laryngeal obstruction, and the reproducibility of subjective manual quantification methods is insufficient, resulting in diagnostic inaccuracy and a poor signal-to-noise ratio in medical research. In this work, a workflow is proposed to quantify laryngeal movements from laryngoscopic videos, to facilitate the diagnosis procedure. Methods: The proposed method analyses laryngoscopic videos, and delineates glottic opening, vocal folds, and supraglottic structures, using a convolutional neural networks (CNNs) based algorithm. The segmentation is divided into two steps: A bounding box which indicates the region of interest (RoI) is found, followed by segmentation using fully convolutional networks (FCNs). The segmentation results are statistically quantified along the temporal dimension and processed using singular spectrum analysis (SSA), to extract clear objective information that can be used by the clinicians in diagnosis. Results: The segmentation was validated on 400 images from 20 videos acquired using different endoscopic systems from different patients. The results indicated significant improvements over using FCN only in terms of both processing speed (16 FPS vs. 8 FPS) and segmentation result statistics. Five clinical cases on patients have also been provided to showcase the quantitative analysis results using the proposed method. Conclusion: The proposed method guarantees a robust and fast processing of laryngoscopic videos. Measurements of glottic angles and supraglottic index showed distinctive patterns in the provided clinical cases. Significance: The proposed automated and objective method extracts important temporal laryngeal movement information, which can be used to aid laryngeal closure diagnosis

High prevalence of laryngeal obstruction during exercise in severe asthma

Exertional dyspnea is a key and pervasive feature in severe asthma and often persists despite optimization of asthma treatment (1). Laryngeal or vocal cord dysfunction, an inappropriate and excessive closure of the glottis during the breathing cycle, is recognised to be present in up to half of severe asthmatics (2,3). This laryngeal closure can lead to transient airflow obstruction during exercise and exertional dyspnea (4). Whilst the normal response of the laryngeal structures is to abduct during exercise, in some individuals, the glottic aperture can narrow inappropriately during exercise. It is currently unclear whether laryngeal closure is present and contributes to the aetiology of exertional dyspnea in patients with severe asthma, yet such a finding may explain the ‘treatment refractory’ nature of this symptom and have implications for management. The aim of this study was to evaluate exercise-related laryngeal function in a cohort of patients with severe asthma and exertional dyspnoea. We utilised the technique of continuous laryngoscopy during exercise (CLE) and hypothesised that laryngeal obstruction would be prevalent and relate to lung function, dyspnoea and exercise intolerance

Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.European Academy of Allergy and Clinical Immunolog

Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs

Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement

Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. ILO is an important cause of a variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has been hampered by imprecise nomenclature and variable approaches to assessment and management. A task force of the European Respiratory Society (ERS) and European Laryngological Society (ELS) was thus set up to address this, and to identify research priorities. A literature search identified relevant articles published until June 2016, using all identifiable terms for ILO, although including only articles using laryngoscopy. In total, 172 out of 252 articles met the inclusion criteria, summarised in sections on diagnostic approach, aetiology, comorbidities, epidemiology and treatment. The consensus taxonomy published by ERS, ELS and the American College of Chest Physicians (ACCP) in 2015 is used throughout this statement. We highlight the high prevalence of ILO and the clinical impact for those affected. Despite recent advances, most aspects of this condition unfortunately remain incompletely understood, precluding firm guidance. Specifically, validated diagnostic and treatment algorithms are yet to be established, and no randomised control studies were identified in this search; hence we also make recommendations for future research