'I felt as if a weight had been lifted off my shoulders,' said Rebecca
Rebecca Eno was used to feeling a bit puffed after exercise. She regularly pushed her body to the limit and was a competitive rower for her school team. However, after one training session in 2010, when Rebecca was just 17, not only did her breathing not return to normal — it got worse. ‘People talk about fighting for breath and that’s what I felt — I just could not grab in enough air to breathe properly,’ says Rebecca, 20, a biology and chemistry student at Durham University. ‘It felt as if someone was trying to strangle me.’ She was in such distress an ambulance was called. Paramedics gave her oxygen and she also used her inhaler as she is mildly asthmatic, but her wheezing did not improve. After half an hour, just as she was starting to panic, her breathing returned to normal of its own accord.
Ambulance staff told her it was an attack of exercise-induced asthma. It sounded a reasonable diagnosis. Exercise, though beneficial, can bring on an attack
for many of Britain’s 5.4 million asthmatics. An Asthma UK survey found 76 per cent of
people with asthma say exercise is a trigger for their symptoms. Quite why it
does this is not fully understood, but it’s thought that breathing in more air
as you exercise dries the airways. This triggers the release of chemicals that
make the airways contract, leading to breathlessness. And this becomes worse if
you exercise outside in the cold as this dries the airways further still.
However, normally this should be controllable with an inhaler. The
strange thing about Rebecca’s case was that her inhaler was not doing anything.
Nor did it when the next attacks
occurred. Between February and July that year she had six more, each during her
training sessions. ‘The last attack I had it took 1½ hours for me to recover,’
says Rebecca. ‘I had to be taken out of the rowing boat, put into a speedboat
and taken to an ambulance on the shore, where I was given oxygen and a
nebuliser.’ For a year, specialists at St Mary’s Hospital in Paddington tried
her on a variety of asthma medications. Yet none worked. The issue was that
while Rebecca has asthma, it wasn’t this that was causing the breathlessness
when she exercised. The problem was
coming from her voice box — and if it wasn’t for a new test there is every
chance her breathlessness would still be mistaken for asthma. What she has is
called exercise-induced laryngeal obstruction (EILO).
It’s essentially a spasm of the voice box and the vocal cords (the thin
membranes that sit over the voice box at the top of the windpipe). The symptoms
— wheezing and breathlessness — are almost identical to asthma, and until now
there has been no easy way to tell the difference. The problem is that the
treatment for each condition is entirely different. EILO will not respond to
inhalers because while asthma is caused by overly sensitive airways in the
lungs that inflame through exposure to allergens or, indeed, exercise, EILO is
caused by the vocal cords closing over the windpipe during exercise.
A study is under way to see if having asthma makes you more prone to
EILO, and if any age groups are especially at risk. EILO is helped by
physiotherapy and learning to breathe through the nose (this warms the air
before it goes into the lungs; cool air is likely to trigger EILO). It’s
estimated that thousands of people, if not more, may be taking asthma
medication needlessly. There are no accurate figures yet, but one study
published in the medical journal Chest in 2003 found that at least 5 per cent of all
athletes suffer from it.
Exercise, though beneficial, can bring on an attack for many of Britain's 5.4 million asthmatics
A paper in the European Respiratory Society’s journal last year said
that while the frequency of EILO among the general population remains unknown,
it ‘could also have a major influence’ on the diagnosis of those with
asthma-like symptoms. ‘Normally, the vocal cords should stay completely out of
the way during exercise, but what we see with EILO is the cords almost
completely closing, which generates a lot of discomfort, wheezing and breathing
difficulty,’ says Dr Andrew Menzies-Gow, a consultant respiratory physician at
the Royal Brompton Hospital. ‘This can be a problem for anyone exercising, and
for an elite athlete it can be critical. ‘Why the vocal cords close in this way
in some people we don’t know. 'Normally, they move to make speech and move over
the windpipe when we swallow to stop food going into the lungs. ‘It may be that
when you breathe deeply during exercise, the turbulence of the breath being
forced past makes them shut in some people.’
The only slight difference between the symptoms of EILO and asthma is
that the wheeze is more pronounced when you breathe in with EILO — and
when you breathe out with asthma. ‘However, if you are struggling to
breathe properly then you won’t notice at what point exactly you wheeze more —
and if you tell your GP you are wheezing and breathless after exercise, they
will most probably initially diagnose asthma,’ says Dr Menzies-Gow. Some may
solely have the vocal cord problem, while others might have asthma as well. ‘About
5 per cent of
people with asthma have severe asthma and do not respond well to medication and
may need admission to hospital for help with their breathing. ‘It may be that
some of these people also have EILO and that by using physiotherapy to help
this the symptoms of their asthma will improve, too,’ says Dr Menzies-Gow.
Until now there has been no easy way to diagnose EILO, but now there is
a new test that can diagnose it on the spot. It involves inserting a tiny
camera — about half as thick as a pencil — up the nose to look at the back of
the throat. The patient is then asked to pedal on an exercise bike or use a
treadmill to replicate symptoms. This test was imported from Denmark and is
being used at the Royal Brompton Hospital in South-West London. It should soon
be available more widely. The camera allows the team to watch any movement of
the vocal cords and the results are recorded on to a computer.
Over the past six months the team at the Royal Brompton have done ten
tests in young adults and 25 others in severe asthmatics in a study funded by
Asthma UK — a large number has been found to have the vocal cord problem as
well as asthma. For Rebecca it’s been life-transforming. Her local hospital had
said there was no more they could do to help with her ‘asthma’ and she faced
having to give up the sport she loved. Luckily, a consultant had heard about
the new test and thought Rebecca would be a good candidate to try it. ‘When
they told me that my results showed I had EILO, I felt as if a weight had been
lifted off my shoulders. 'Half an hour later I was on my way to see the
physiotherapist to learn how to manage my condition.’ Since then she has been
doing her exercises almost daily. ‘It takes a long time to build up — at first,
I would do the techniques for 30 seconds. 'I have to get up to 25 minutes
before I can start proper training, but I hope to get there in eight weeks,’
she says. ‘If I hadn’t had the test, things could have turned out very
differently for me.’
Source: Daily Mail UK
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