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Use of Inhaled ipratropium bromide to improve exercise induced laryngeal obstruction cannot be recommended

Praveen Muralitharan, Petter Carlsen, Magnus Hilland, Irisz Delestre-Levai, Maria Vollsæter, Karl Ove Hufthammer, Mette Engan, Ola Drange Røksund, Thomas Halvorsen, Hege H. Clemm
ERJ Open Research 2022; DOI: 10.1183/23120541.00308-2022
Praveen Muralitharan
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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  • For correspondence: praveen.muralitharan@helse-bergen.no
Petter Carlsen
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Magnus Hilland
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Irisz Delestre-Levai
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Maria Vollsæter
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Department of Clinical Science, University of Bergen, Bergen, Norway
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Karl Ove Hufthammer
3Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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  • ORCID record for Karl Ove Hufthammer
Mette Engan
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Ola Drange Røksund
2Department of Clinical Science, University of Bergen, Bergen, Norway
4Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Thomas Halvorsen
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Department of Clinical Science, University of Bergen, Bergen, Norway
5Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Hege H. Clemm
1Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Department of Clinical Science, University of Bergen, Bergen, Norway
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Abstract

Introduction Exercise induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training (IMT), or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic-receptor antagonist used to treat asthma, and suggested in a few reports to improve EILO symptoms.

Aim To investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE-scores.

Methods A randomized crossover trial, conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE-score≥3 (range 0–12). Two consecutive CLE-tests were performed within two weeks, one test with and one test without prior administration of inhaled IB in a randomized order. Main outcomes were the CLE-score, dyspnoea measured using a modified BORG scale (range 0–10) and cardiopulmonary exercise data provided by the CLE-test.

Results Twenty participants (14 females) aged 12–25 years participated, and all ran to exhaustion on both tests. Mean CLE-score, Borg score, and peak oxygen consumption were similar in tests performed with and without IB, mean differences (95% confidence interval) were 0.08 (−0.28 to 0.43), 0.35 (−0.29 to 0.99), and −0.4 (−1.9 to 1.1) ml−1 kg·min−1, respectively.

Conclusion Inhaled IB did not improve CLE-score, dyspnoea, or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: The authors have no conflicts of interest to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received June 24, 2022.
  • Accepted October 18, 2022.
  • Copyright ©The authors 2022
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

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Use of Inhaled ipratropium bromide to improve exercise induced laryngeal obstruction cannot be recommended
Praveen Muralitharan, Petter Carlsen, Magnus Hilland, Irisz Delestre-Levai, Maria Vollsæter, Karl Ove Hufthammer, Mette Engan, Ola Drange Røksund, Thomas Halvorsen, Hege H. Clemm
ERJ Open Research Jan 2022, 00308-2022; DOI: 10.1183/23120541.00308-2022

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Use of Inhaled ipratropium bromide to improve exercise induced laryngeal obstruction cannot be recommended
Praveen Muralitharan, Petter Carlsen, Magnus Hilland, Irisz Delestre-Levai, Maria Vollsæter, Karl Ove Hufthammer, Mette Engan, Ola Drange Røksund, Thomas Halvorsen, Hege H. Clemm
ERJ Open Research Jan 2022, 00308-2022; DOI: 10.1183/23120541.00308-2022
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