Interpreting Airway Tests in Athletes with Exertional Breathlessness

Abstract

To evaluate how exercise protocol, laryngeal observation, and serial expiratory measurements affect diagnosis and treatment assessment in athletes with exertional breathlessness. This study is a critical narrative review of physiological timing, diagnostic comparisons, grading agreement, athlete cohorts, and treatment outcomes. Appraisal addressed recruitment, exercise exposure, outcome assessment, comparison groups, and follow-up completeness. Continuous laryngoscopy during exercise (CLE) documents glottic and supraglottic behaviour during provocation. In ten patients, constant work at 70%, 80%, or 90% of maximal exercise capacity elicited obstruction comparable to incremental testing in 70–90% of cases. Serial postchallenge forced expiratory volume in one second (FEV₁) measurements assess bronchoconstriction. In a separate cohort, ten of 29 endurance athletes without perceived breathing problems had supraglottic grades of at least 2, demonstrating the need for symptom-compatible interpretation. Treatment cohorts showed changes in breathing symptoms and CLE scores, but lacked randomised comparators and had substantial selection or follow-up limitations. A negative airway test is interpretable only in relation to the provocation delivered and the anatomical process measured. Assessment of treatment should retain the exercise workload, symptom course, airway findings, and ability to participate in sport.