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.