PEDIATRICS Vol. 90 No. 2 August 1992, pp. 293-295
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Upper Airway Disorders

PATHOPHYSIOLOGY

LARYNGEAL CHANGES DURING EXERCISE AND EXERCISE-INDUCED ASTHMA

Hurbis CG, Schild JA. Ann Otol Rhinol Laryngol. 1992;100:34-37.

Purpose of the Study

This study was performed to determine the effect of exercise on the larynx in healthy and asthmatic patients.

Study Population

Thirty subjects aged 18 to 35 years were studied. There were 15 healthy subjects and 15 with only exercise-induced asthma.

Methods

All subjects had an endoscopic examination of their laryngeal area where photographic images were recorded for measurement of inspiratory and expiratory glottic areas. All were then exercised at 75% to 85% of their predicted maximum heart rate for 8 minutes, breathing cold dry air. Laryngoscopy and pulmonary functions were performed after 8 minutes of exercise and again after 5 minutes of rest.

Findings

In healthy individuals and in asthmatic patients whose forced expiratory volume changed less than 5%, the laryngeal opening increased in size, whereas asthmatics whose forced expiratory volume dropped in excess of 5% showed a narrowing of the glottic area.

Conclusions

The normal enlargement of the glottic space allows for less resistance, making the increase of minute volume that is demanded by exercise less energy-intense. The moderate asthmatic, on the other hand, has a decrease in size to further increase the work of breathing. The benefits of such an increase may be an endogenous method to apply positive end-expiratory pressure, thus keeping airways open.

Comments

As I read this I couldn't help think of the asthmatic who is so hard to manage with laryngeal spasm. Perhaps these people have an exaggerated and prolonged physiologic response.