How is this different from asthma?

Asthma is a lower-airway problem: expiratory wheeze from the chest, responsive to a reliever. Inducible laryngeal obstruction is at the throat: difficulty breathing in, noise at the neck, onset at peak effort, resolution within minutes of stopping, and little response to an inhaler.

Yes, and many people do — which is one reason it goes unrecognised. Never stop asthma treatment on the basis of suspecting this; get both assessed.

When the throat closes on exertion: the condition mistaken for asthma

At peak effort your throat shuts. The difficulty is getting air in, it is noisy at the neck rather than wheezy in the chest, it resolves within minutes of stopping, and your inhaler has never made much difference.

Do this now

Rescue breathing at the throat

2 minutes

Stop the effort and stand or lean forward with your forearms supported. Do not panic-gulp for air.
Breathe in through the nose only, gently, with the tongue resting low and the jaw loose.
Breathe out through pursed lips, longer than the inhale. The out-breath is the part that unloads the larynx.
Keep the inhale gentle and nasal — a hard sniff pulls the vocal folds together and makes it worse.
Continue for one to two minutes. It usually resolves quickly, which is itself a diagnostic clue.

Run it with a timer

What is happening at the larynx

In inducible laryngeal obstruction — previously called vocal cord dysfunction or exercise-induced laryngeal obstruction — structures at the larynx move inward during inspiration at high airflow, narrowing the airway at the throat rather than in the lower airways. The result is inspiratory difficulty and noise at the neck, in contrast to asthma's expiratory wheeze from the chest.

Why it is so often called asthma

Both cause exertional breathing difficulty in young, often athletic people. The distinguishing features are the location and timing: throat rather than chest, harder to breathe in rather than out, onset at peak effort with rapid resolution within minutes of stopping, and little response to a reliever inhaler. It is diagnosed properly with continuous laryngoscopy during exercise, which is the test to ask about. Misdiagnosis means years of escalating asthma medication that was never going to work.

Why the breathing technique is the treatment

Speech-and-language therapy breathing retraining is the mainstay: gentle nasal inspiration with a relaxed larynx, pursed-lip or extended exhalation, and rescue patterns rehearsed until they are automatic at peak effort. It works because the obstruction is a movement pattern rather than inflammation, and movement patterns respond to training. This is one of the few conditions where a breathing technique is the primary intervention rather than an adjunct.

What changes it, over a week

Daily, five minutes
Gentle nasal inhale, long pursed-lip exhale, jaw and tongue relaxed. Rehearse it calm so it is available at effort.
During training
Use the pattern from the start of hard efforts, not only when the throat tightens.
Warm up longer
A gradual, extended warm-up reduces episodes for many people. Going hard from cold is the common trigger.
This month
Ask specifically about inducible laryngeal obstruction, continuous laryngoscopy during exercise, and referral to speech-and-language therapy.

When this is not a breathing pattern

See a clinician — promptly, and before assuming any of this applies to you — if any of these describe you:

Any episode with blue lips, loss of consciousness, or that does not resolve within minutes of stopping — emergency assessment
Difficulty breathing at rest, or noisy breathing that is present when you are not exercising
A hoarse voice lasting more than three weeks, or difficulty swallowing
Do not stop asthma medication on the basis of this page — the two conditions frequently coexist, and that decision is your clinician's
Symptoms that began after a choking episode, intubation, or neck surgery

This page is education, not medical advice, and no part of it is a diagnosis. Full disclaimer.

Questions people ask

How is this different from asthma?: Asthma is a lower-airway problem: expiratory wheeze from the chest, responsive to a reliever. Inducible laryngeal obstruction is at the throat: difficulty breathing in, noise at the neck, onset at peak effort, resolution within minutes of stopping, and little response to an inhaler.
Can I have both?: Yes, and many people do — which is one reason it goes unrecognised. Never stop asthma treatment on the basis of suspecting this; get both assessed.
Does breathing retraining work?: It is the first-line management, delivered by speech-and-language therapists, because the obstruction is a movement pattern rather than inflammation. Results are often good and it is worth asking for by name.

What this page is built on

— Halvorsen et al., 2017, European Respiratory Journal — inducible laryngeal obstruction: an official joint ERS/ELS/ACCP statement
— Christensen et al., 2011, European Respiratory Journal — exercise-induced laryngeal obstructions, prevalence in athletes
— Traditional: speech-and-language therapy breathing retraining, the established first-line management

Named by author and year. The DOIs live in the journal.

Put a number on it

Most of what is on this page tracks one measurement: the Control Pause. It takes sixty seconds, needs no account, and it is the thing that tells you whether any of this is working.