%0 Journal Article %A Praveen Muralitharan %A Petter Carlsen %A Magnus Hilland %A Irisz Delestre-Levai %A Maria Vollsæter %A Karl Ove Hufthammer %A Mette Engan %A Ola Drange Røksund %A Thomas Halvorsen %A Hege H. Clemm %T Use of Inhaled ipratropium bromide to improve exercise induced laryngeal obstruction cannot be recommended %D 2022 %R 10.1183/23120541.00308-2022 %J ERJ Open Research %P 00308-2022 %X 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.FootnotesThis 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. %U https://openres.ersjournals.com/content/erjor/early/2022/10/13/23120541.00308-2022.full.pdf