Why an inhaler might not be helping your athlete’s breathing during exercise

For many athletes, experiencing breathing difficulty during exercise leads to a common first step: using an inhaler. When symptoms like shortness of breath, chest tightness, or sudden breathing restriction occur during activity, asthma is often suspected. But what happens when your inhaler isn’t helping during exercise?

If you or your athlete still struggles to breathe during intense exercise despite using asthma medication, the underlying issue may not be asthma at all. In many cases, breathing difficulty during exercise can be caused by exercise-induced laryngeal obstruction, also known as vocal cord dysfunction. Understanding the difference can help athletes find the right treatment and return to performing at their best.

When Inhalers Work

Asthma inhalers are designed to treat asthma or exercise-induced bronchoconstriction, conditions that affect the lower airway.

During an asthma flare or exercise-induced bronchoconstriction:

• The airways in the lungs narrow
• Inflammation increases
• Breathing becomes difficult, especially when exhaling

Rescue inhalers work by relaxing the muscles around the bronchial tubes, allowing air to move more easily through the lungs. For athletes with asthma, inhalers can significantly improve breathing during and after exercise.

When Inhalers Don’t Work

If breathing difficulty persists despite using an inhaler, it may be due to a problem outside the lungs.

One increasingly recognized cause of breathing problems during exercise is Exercise-Induced Laryngeal Obstruction (EILO).

EILO affects the upper airway, specifically the larynx (voice box), rather than the lungs. Because asthma inhalers treat the lower airways, they typically do not improve symptoms caused by EILO.

What Is EILO?

Exercise-Induced Laryngeal Obstruction occurs when structures in the larynx temporarily narrow during intense exercise. Instead of staying open to allow air to flow freely, parts of the airway partially close, making it difficult to breathe in. This narrowing typically happens during high-intensity effort and often resolves quickly when exercise stops.

Why Is EILO Often Confused With Asthma?

Breathing problems during exercise are commonly assumed to be asthma because the symptoms can look similar. However, important differences exist.

Athletes with asthma often experience:

• Wheezing in the chest
• Coughing during or after exercise
• Symptoms that improve with inhaler use

Athletes with EILO often notice:

• Difficulty breathing in, rather than out
• Tightness in the throat instead of the chest
• Symptoms appearing at peak intensity
• Rapid improvement after stopping exercise

Because the symptoms overlap, athletes are frequently treated for asthma first before other causes are considered.

How is EILO diagnosed?

The most accurate way to diagnose EILO is through a procedure called the Continuous Laryngoscopy Exercise Test (CLE test).

During this test:

1. A small camera is placed through the nose.
2. The athlete exercises on a treadmill or bike.
3. Clinicians observe how the airway behaves during exertion.

This allows providers to directly visualize whether the larynx is narrowing during exercise.

Treatment for EILO

The primary treatment for EILO involves breathing and airway control techniques designed to help athletes maintain an open airway during intense activity.

With proper training, athletes can learn strategies to:

• Reduce throat tension during exercise
• Improve airflow during high-intensity effort
• Maintain better breathing control under stress

Many athletes experience significant improvement and can return to sport without breathing limitations.

When to Seek An Evaluation

Consider seeking evaluation if you or your athlete:

• Experience breathing difficulty mainly during intense exercise
• Notice throat tightness or noisy breathing during activity
• Have asthma medication that does not improve symptoms
• Recover quickly once exercise stops

Identifying the true cause of breathing difficulty is the first step toward effective treatment.

The Takeaway

If your inhaler isn’t helping your breathing during exercise, asthma may not be the only explanation.

For many athletes, the underlying issue may be exercise-induced laryngeal obstruction, a condition that affects the airway in the throat rather than the lungs.

With the right diagnosis and targeted breathing strategies, athletes can often return to training and competition breathing more comfortably and performing at their full potential.