Synopsis
Recognise inducible laryngeal obstruction and dangerous upper-airway mimics, confirm dynamic disease during symptoms, and replace unnecessary asthma escalation with specialist breathing and laryngeal care.
- Inducible laryngeal obstruction is the preferred term for transient inappropriate glottic or supraglottic closure during breathing; 'vocal cord dysfunction' is older and anatomically narrower.
- ILO episodes usually begin suddenly with inspiratory difficulty, throat tightness and noisy breathing after a trigger, then settle relatively quickly when the trigger stops.
- Asthma more typically causes expiratory airflow limitation and chest symptoms, but ILO and asthma commonly coexist, so an either-or assumption is unsafe.
Key red flags
Acute airway or breathing difficulty with urticaria, flushing, hypotension, gastrointestinal symptoms or known allergen exposure is anaphylaxis until treated, even when throat tightness resembles previous ILO.
Investigation priorities
Identify immediate airway danger and localise airflow limitation.
Management branches
A patient presents with acute throat tightness, noisy breathing or apparent upper-airway obstruction.
- Perform ABCDE and look for swelling, rash, hypotension, foreign-body history, infection, trauma, voice change, hypoxaemia, exhaustion and altered consciousness.
- Call anaesthetic and ENT support early for threatened airway; treat anaphylaxis immediately with intramuscular adrenaline and follow the local emergency algorithm.
Key medicines
No routine medicine for isolated ILOThere is no drug dose: use specialist speech and language therapy with individually taught breathing and laryngeal-control techniques.
Intramuscular adrenaline for anaphylaxisGive 500 micrograms intramuscularly using 1 mg/mL adrenaline in the anterolateral thigh, repeating after five minutes if airway, breathing or circulation problems persist.