What are vocal cord dysfunction and exercise induced laryngeal obstruction?
Vocal cord dysfunction is a condition where the vocal cords or nearby tissues in the voice box (larynx) close instead of opening during inhalation (breathing in). When symptoms mainly happen during physical activity or sports, it is called exercise-induced laryngeal obstruction. For an overview of the condition, including the signs, symptoms and possible triggers, please see Vocal cord dysfunction (VCD) and exercise-induced laryngeal obstruction (EILO): Overview.
How are VCD and EILO managed?
VCD and EILO can generally be managed by learning about the condition, using rescue breathing techniques and respiratory training. These strategies are described below.
Learning about the condition and identifying triggers
Education is a key part of your child’s treatment plan. The first step in managing your child’s symptoms is to learn about the anatomy, physiology and mechanics of breathing. It is also important to identify your child’s trigger(s). There may be one or several things that act as a trigger for your child. Examples of possible triggers include exercise, allergies, post-nasal drip, strong smells, stress, extreme temperature changes and reflux (heartburn). Some of these triggers may be managed with medications, while others will require different treatment approaches. Your child’s health-care team will be able to guide you. Note that asthma puffers do not work for VCD or EILO.
Rescue breathing techniques
It can be scary for your child to feel like they cannot get air into their lungs. Rescue breathing techniques quickly remind the body how to open the vocal cords, allowing your child to get air back into their lungs. These techniques also help your child re-establish a sense of calm and control over their breathing. Some examples of rescue breathing include the sniff technique and the EILOBI techniques (see videos below).
Sniff technique
EILOBI breathing techniques: Lip and tooth variants
It is helpful for your child to practise these techniques on their own or with their health-care provider even when they are not experiencing symptoms. It is important to get very comfortable with these techniques while at rest and then gradually implement them with increasing levels of exercise.
Respiratory retraining
The larynx not only creates your voice but also protects the lower airway by bringing the vocal cords together. People with VCD/EILO can get stuck in a dysfunctional breathing pattern where the vocal cords try to close when they should be open to allow air in. An important part of the treatment plan for VCD/EILO focuses on reprogramming those muscles involved in breathing with a speech-language pathologist or another health-care provider with experience in treating VCD/EILO. These approaches include diaphragmatic (belly) breathing and traditional voice therapy techniques aimed at reducing tension in the larynx. These help to retrain the vocal cords to stay open when your child is breathing in and out.
Many people with VCD/EILO may also develop less efficient breathing patterns called dysfunctional breathing or breathing pattern disorders (BPD). BPD refers to an inefficient or altered way of breathing that can make it feel harder to catch your breath, especially during exercise or stressful situations. This might include breathing too quickly or taking shallow breaths, using the upper chest muscles too much or relying on mouth breathing. These changes can lead to symptoms such as chest tightness and a feeling of not getting enough air. They can also make it difficult to breathe well during exercise and sometimes at rest. Research has shown that people with BPD may be more likely to experience EILO. Like VCD and EILO, BPD can be treated with respiratory retraining and the right support.
Managing stress and other conditions
Stress, anxiety or the pressure of competition may contribute to VCD/EILO. Working with a health-care provider, such as a sports psychologist, social worker or counsellor, can be helpful to identify these potential triggers and target them directly in a way that is specific to your child and their situation.
If your child has EILO, it is also important that they stay active and continue participating in exercise at a level that feels comfortable to help rebuild or maintain confidence and support recovery. Remember that some people can have both VCD/EILO and asthma, so it is important that asthma is well controlled in order for your child to get the most benefit from their VCD/EILO treatment plan.
Other considerations and treatment options
It is important that your child’s caregivers, coaches and friends learn about VCD/EILO and how they can be supportive when symptoms are triggered. When everyone has a better understanding of VCD/EILO, there is less potential for panic, which can worsen the situation.