When It’s Not Asthma: Understanding EILO in Athletes

You’re mid-race, pushing through your hardest interval, and suddenly you can’t get air in. Your throat feels tight. Your breathing turns noisy. You have to stop.

For many athletes, the first answer they get is asthma. But a growing number of those athletes actually have something else entirely: exercise-induced laryngeal obstruction, or EILO — also known as vocal cord dysfunction or paradoxical vocal fold motion.

The two conditions can feel nearly similar in the moment. But they involve different parts of the airway, respond to different treatments, and need to be properly distinguished to get athletes back to peak performance.

What is EILO?

EILO happens when the larynx — the voice box in the upper airway — narrows during intense exercise. Rather than staying open to allow airflow, structures in the larynx partially close, making it feel like breathing through a straw. The onset is sudden, typically tied to high-intensity effort, and almost always resolves quickly once the athlete slows down or stops.

EILO most often affects runners, swimmers, soccer players, and other field sport athletes. It’s especially common in adolescents, young adults, and highly competitive athletes and can significantly impact both performance and confidence.

What is asthma?

Asthma is a chronic inflammatory condition affecting the lungs. During exercise, it can trigger what’s called exercise-induced bronchoconstriction — narrowing of the bronchi in the lower respiratory tract. This leads to chest tightness, wheezing, coughing, and shortness of breath that may persist well after activity ends.

Unlike EILO, asthma affects the lungs — not the throat.

Why is EILO so often missed?

Because both conditions cause breathing difficulty during exercise, athletes with EILO frequently end up being treated for asthma first. But there are telling signs that the real issue may be EILO:

• Inhalers don’t improve symptoms
• Breathing difficulty is most intense at peak effort
• Symptoms resolve quickly when slowing down or stopping

It’s also worth noting that EILO and asthma can coexist — making accurate evaluation even more critical.

When to seek an evaluation

Consider getting evaluated if you or your athlete:

• Struggles to breathe during intense exercise
• Has asthma treatment that isn’t working
• Notices noisy breathing during activity
• Feels throat tightness while training or competing

The bottom line

EILO and asthma may look similar from the outside, but they’re distinct conditions affecting different parts of the airway. The right diagnosis changes everything — from the treatment approach to the outcome. Getting there is the first step toward breathing easier and performing at your best.

Contact Functional Airway Lab today to learn more. In-person appointments are available at our Ventura, California office. Virtual telehealth sessions are available across California, Arizona, Colorado, Idaho, and Nevada.

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Dr. Karie Marsh, SLPD, CCC-SLP, is a licensed speech-language pathologist and EILO specialist at Functional Airway Lab in Ventura, CA. She holds a clinical doctorate in speech-language pathology from Rocky Mountain University of Health Professions, where her research focused on EILO in adolescent and young adult athletes.