ObjectivesAsthma and bronchial hyperresponsiveness is common in athletes, particularly in sports with high ventilatory demands or exposure to irritants such as cold, dry air, polluted air, or trichloramines. The mechanisms behind asthma in athletes remain unclear, but repeated high-volume ventilation and exposures to irritants, as well as airway inflammation and remodelling likely contribute. Symptoms resemble those of asthma, and airway hyperresponsiveness plays a key role, even in athletes with no other classic asthma features. Treatment of asthma in athletes follows the same approach as asthma in the general population. Use of asthma medication is commonly reported by athletes on doping control forms (DCFs). Thus, this study aimed to investigate the use of different anti-asthmatic medications among doping-controlled athletes.MethodsThis was an observational cross-sectional study, evaluating retrospective data from athletes′ DCFs obtained during 2015–2019 as part of Anti-doping Norway′s national testing program in Norwegian sport, some of whom reappearing in the data set with multiple forms.ResultsOf 10 418 DCFs, 1702 (16.3%) contained one or more anti-asthmatic medications. Bronchodilators were most frequently reported, with anticholinergics being most common. DCFs reported from females, national level athletes, and athletes with high risk of asthma contained significantly more anti-asthmatic medications compared to their counterparts (p < 0.01). Usage was highest among athletes aged 30–34, and in those in endurance sports.ConclusionDespite the limitation of athletes’ reappearance in the dataset, this study provides insight into guideline adherence and asthma medication use among athletes in Norway. Further research is needed in this area.

AIMS:We aimed to systematically evaluate standard 12‑lead electrocardiograms (ECG) in young individuals with exercise-induced laryngeal obstruction (EILO), with a special focus on the prevalence and clinical significance of T-wave inversion (TWI). METHODS AND RESULTS:235 individuals (mean age 16.7 years, 85% females) presenting to the EILO Clinic, underwent 709 high-intensity cardiopulmonary exercise treadmill testing with continuous visualization of the larynx (CLE- Continuous Laryngoscopy Exercise). There was no adverse event during exercise tests. The prevalence of TWI (negatively deflected T-wave ≥1 mm (0.1 mV amplitude) in any 2 contiguous leads excluding aVR, III, and V1) was 42.6% (18.7% isolated in the inferior wall leads, 13.2% in the inferolateral leads, 5.1% in both the inferior and anterior leads, 3% both in the inferior and anteroseptal leads, 2.1% isolated in anteroseptal leads and 0.9% isolated in anterior wall leads). Age, body height and weight, exercise duration and peak oxygen uptake did not differ between individuals with versus without TWI (all p > 0.05). There was a trend towards lower total CLE score in individuals with TWI (4.2 vs 4.5, p = 0.070). Individuals with TWI had higher resting heart rate (98 vs 95 bpm, p = 0.05), shorter PQ-interval (124 vs 129 ms, p = 0.020) and achieved higher peak heart rate (193 vs 189 bpm, p = 0.005) and metabolic equivalents during exercise (13.4 vs 12.9, p = 0.028). CONCLUSIONS:High-intensity CLE-test in individuals with EILO was not associated with any adverse cardiac findings. TWI was highly prevalent and particularly observed in the inferior or inferolateral wall leads but had no association with energetic decline or cardiac dysfunction.

Purpose: Long-term non-invasive ventilation (NIV) is an established therapy for hypercapnic chronic obstructive pulmonary disease (COPD); however, many patients remain challenging to ventilate effectively. We hypothesized that NIV-induced laryngeal obstruction (NIV-ILO), observed during laryngoscopy, may contribute to reduced ventilatory effectiveness, and that this obstruction can be identified using laryngeal ultrasound (US). Patients and Methods: This exploratory cross-sectional study included 15 participants with stable COPD receiving long-term NIV. Laryngeal responses were assessed using transnasal flexible laryngoscopy (TFL) and US. Assessments began during spontaneous breathing, followed by NIV at each participant's prescribed settings. Inspiratory positive airway pressure (IPAP) was increased in 2 cmH2O increments to the device's maximum. Laryngeal responses were assessed in real time and reassessed retrospectively from video recordings. The participants rated discomfort using a numeric rating scale (0-10). Results: Fifteen participants (40% female) were included. The prescribed IPAP ranged from 7 to 30 cmH2O, with NIV-ILO observed in 5 of 15 participants at a median of 22.0 cmH2O. During subsequent pressure increments, additional 6 of 15 developed NIV-ILO at a median (range) IPAP of 20.5 cmH2O (16.0-30.0), yielding 11 participants (73.3%) developing NIV-ILO within the pressure range of their device. US was assessable in 11 participants, with the structures of interest visualized during 54 of 63 pressure increments. The two methods demonstrated complete concordance for all assessable findings. Conclusion: NIV-ILO was common in patients with COPD using long-term NIV, occurring within the pressure range typically applied to achieve effective ventilation. US can serve as a less invasive diagnostic alternative to TFL.

AIM:To compare self-reported pain sensitivity and the use of pain medication in young adults born extremely preterm (EP) with matched term-born controls. METHODS:In this third follow-up of a population-based cohort study of individuals born EP (gestational age ≤28 weeks) in 1991-92, the Pain Sensitivity Questionnaire (PSQ) was administered together with health-related questions. Matched term-born controls served as a comparison group. RESULTS:At 27 years of age, 24 (69%) EP-born and 26 (74%) term-born controls consented to participate. There were no significant differences between groups in PSQ total, moderate, or minor scores, nor in the use of pain medication. No associations were found between the number of painful procedures in the neonatal period and pain sensitivity at 27 years. CONCLUSION:Self-reported pain sensitivity and use of pain medication at 27 years of age did not differ between adults born extremely preterm and their term-born peers.

OBJECTIVE:Surgery is used to treat exercise-induced laryngeal obstruction (EILO), but high-quality evidence remains limited. We therefore conducted a surgical randomized controlled trial (RCT) evaluating full supraglottoplasty (FSP), minimally invasive supraglottoplasty (MISP), and a wait-and-see control group. METHODS:Patients with symptomatic supraglottic EILO despite conservative management were randomized to FSP, MISP, or control. FSP involved aryepiglottic fold incisions including the tip of the cuneiform tubercle, whereas MISP included six laser punctures in the aryepiglottic folds. Continuous laryngoscopy during exercise (CLE) was performed before and after interventions. Laryngeal obstruction was graded at glottic and supraglottic levels during moderate and maximal exercise (CLE scores). Breathing problems were assessed using patient-reported outcome measure (PROM). RESULTS:Forty-one patients were randomized to FSP (n = 13), MISP (n = 15), or control (n = 13). Between-group comparisons showed that FSP was superior to controls regarding supraglottic CLE scores at moderate intensity (p = 0.036), glottic and supraglottic CLE scores at maximum intensity (p = 0.047 and p < 0.001, respectively). FSP was also superior to MISP for supraglottic CLE scores at maximal intensity (p < 0.001). MISP did not differ from controls for any CLE outcomes. FSP reduced PROM for general breathing difficulties compared to controls (p < 0.001), and MISP (p = 0.042); both FSP and MISP reduced breathing-related PROM during activity (p = 0.039 and p = 0.022, respectively), without corresponding improvements in CLE outcomes for MISP. CONCLUSION:In patients with supraglottic EILO refractory to conservative management, FSP improved both CLE scores and patient-reported outcomes. These findings provide support for FSP in carefully selected patients considered for surgical treatment, while the role of MISP remains uncertain. LEVEL OF EVIDENCE: 2:

Background: Transnasal fiberoptic laryngoscopy (TFL) has revealed that laryngeal obstruction can hamper assisted ventilation. TFL may be considered invasive, and laryngeal ultrasound (US) could be a noninvasive alternative. The objective of this study was to investigate the feasibility of using laryngeal US to study laryngeal movements in healthy adult volunteers undergoing noninvasive ventilation (NIV) and to compare the observations with those of simultaneous TFL. Methods: In this cross-sectional study, 30 participants (19 females, age 22-65 y) underwent simultaneous video-recorded TFL and laryngeal US, breathing with and without NIV. Laryngeal US was repeated for anterior and both lateral approaches; the last 5 breaths from each assessment were analyzed. The participants rated discomfort using a numeric rating scale (NRS) from 0 (no discomfort)-10 (worst). Two blinded raters separately described and scored the TFL and laryngeal US recordings, and the findings were subsequently compared. The last 10 laryngeal US recordings were tested for interrater reliability. Results: All participants were successfully assessed using the anterior and both lateral laryngeal US approaches during NIV. Both techniques were well tolerated; 5/30 scored 0 on NRS for TFL and 22/30 for laryngeal US. The visualization rate for all recorded breaths was 99.1% for TFL compared to 81.7% for laryngeal US; overall concordance rate was 84.6%. The discordance rate for the TFL versus laryngeal US observations was 11.1% for vocal fold movements and 11.7% for aryepiglottic fold movements. Interrater reliability showed substantial agreement (0.71). Conclusions: Laryngeal US emerged as a feasible method to describe laryngeal movements during NIV, providing high-quality observations and high concordance with TFL.

Physical activity is crucial for children’s physical, cognitive, and social development, reducing the risk of non-communicable diseases and improving overall well-being. A major legacy of extremely preterm delivery is respiratory limitation with reduced lung function and decreased exercise capacity which can be further exacerbated by inactivity and deconditioning. Strategies to increase incidental physical activities in early childhood and participation in sport and more formal exercise programmes in middle childhood have the potential to optimize cardiopulmonary function, improve quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain.Intervention strategies such as supervised aerobic and resistance training, and incorporation of physical activity into daily routines have shown promise in increasing activity levels and improving exercise capacity in this population. Engaging families and tailoring programs to individual needs are crucial for the success of these interventions.Overall, a holistic approach that promotes increased physical activity and addresses psychosocial barriers is essential for optimizing the health, well-being, and quality of life of preterm-born children. Further research and development of effective, long-term intervention programs are needed to support these vulnerable individuals throughout childhood and into adulthood.

INTRODUCTION:Exercise- Induced Laryngeal Obstruction (EILO) can lead to disabling exercise related dyspnea and hamper participation in physical activity. In this study, we aimed to investigate the effects of a standardized speech therapy protocol as treatment for EILO. METHODS:Patients diagnosed with EILO at our institution were invited to participate. We compared laryngeal findings obtained during a continuous laryngoscopy exercise (CLE) test and questionnaire based self-reported breathing symptoms, before vs. after the treatment intervention. The laryngeal obstruction was characterized using a standardized CLE scoring system (0-12 points). RESULTS:A total of 28 patients were evaluated. Following speech therapy, the mean reduction in the CLE score was 1.5 (95% confidence interval: 1.1-2.0) points, with the improvement primarily associated with decreased glottic-level obstruction. Twenty-four (86%) patients reported reduced symptoms during exercise. A moderate correlation was observed between changes in CLE scores and subjective symptom improvements. CONCLUSION:This study suggests that a standardized speech therapy protocol reduces observed laryngeal obstruction during the CLE test, with the most notable improvement occurring at the glottic level, alongside a parallel reduction in self-reported symptoms of EILO.

BACKGROUND: Mechanical insufflation-exsufflation (MI-E) uses positive and negative pressures to assist weak cough and to help clear airway secretions. Laryngeal visualization during MI-E has revealed that inappropriate upper airway responses can impede its efficacy. However, the dynamics of pressure transmission in the upper airways during MI-E are unclear, as are the relationships among anatomic structure, pressure, and airflow. RESEARCH QUESTION: Can airflow resistance through the upper airway and the larynx feasibly be calculated during MI-E, and if so, how are the pressures transmitted to the trachea? STUDY DESIGN AND METHODS: Cross-sectional study of 10 healthy adults, where MI-E was provided with and without active cough using pressure settings +20/-40 cm H2O and +/- 40 cm H2O. Airflow and pressure at the level of the facemask were measured using a pneumotachograph, whereas pressure transducers (positioned via transnasal fiber-optic laryngoscopy) recorded pressures above the larynx and within the trachea. Upper airway resistance (Ruaw) and translaryngeal resistance (Rtl) were calculated (in centimeters of water per liter per second) and were compared with direct observations via laryngoscopy. RESULTS: Positive pressures reached the trachea effectively, whereas negative tracheal pressures during exsufflation were approximately one-half of the intended settings. Insufflation pressure increased slightly when passing through the larynx. Participant effort influenced tracheal pressures and the resistances, with findings consistent with laryngoscopic observations. During MI-E, resistance seems to be dynamic, with Ruaw exceeding Rtl. Inappropriate laryngeal closure increased Rtl during both positive and negative pressures. INTERPRETATION: We found that Ruaw and Rtl can be calculated feasibly during MI-E. The findings indicate different transmission dynamics for positive and negative pressures and that resistances are influenced by participant effort. The findings support using lower insufflation pressures and higher negative pressures in clinical practice. CHEST 2025; 167(1):188-201

Chronic or long-term illnesses in early years increase the risk of comorbidities such as mental disorders, social exclusion, and difficulties in forming relationships. In Bergen, Norway, the three-phased intervention Life Coping Program is established. This program is designed to support adolescents with chronic or long-term illnesses through tailored preparation, a hospital-based Life Coping Course, and structured follow-up aimed at empowering them to actively manage their health and adopt a more active lifestyle. This protocol paper describes a feasibility trial of the Life Coping Program, focused on improved health-related quality of life (HRQoL) and levels of physical activity. This study is based on the British Medical Research Council’s (MRC) modified framework for developing and evaluating complex interventions. Feasibility and acceptability of the Life Coping Program will be evaluated in an uncontrolled open-label trial using quantitative measures. Sixty children and adolescents with chronic illness or severe medical conditions will be recruited along with one associated caregiver. Feasibility will be assessed by tracking attendance and participation in the different parts of the intervention. Acceptability of the intervention will be assessed by patient-reported questionnaires. HRQoL and levels of physical activity will be measured using the KidScreen-27 and Actigraph GT3X + monitor, respectively, at baseline and 1 and 6 months post-intervention. The study will explore the feasibility of an innovative treatment strategy targeting children and adolescents at risk of poor health-related outcomes across multiple dimensions. The findings will inform the design of a future randomized controlled trial. Trial registration. ClinicalTrials.gov, NCT06709248. Registered 15th of November 2024—retrospectively registered, https://clinicaltrials.gov/study/NCT06709248?term=NCT06709248 rank=1

The interaction between anatomical structures, pressure, and airflow impacts the airway resistance. The airflow during noninvasive ventilation (NIV) relies on the upper airway and laryngeal patency. This study aimed to quantify the airflow resistance at these levels during NIV. In this cross-sectional study examining 10 healthy, awake adults, we established a NIV setup incorporating a continuous video-recorded transnasal laryngoscopy and simultaneous airway pressure measurement using a transducer positioned above and below the vocal folds. Airflow and mask pressure were recorded by a pneumotachograph at the mask. NIV was delivered with inspiratory positive pressure (IPAP)/expiratory positive pressure (EPAP) set to 10/4 and 15/4 cmH2O. Upper airway (Ruaw) and translaryngeal (Rtl) resistance were calculated and compared with laryngoscopic findings. During IPAP10/EPAP4, the Ruaw was 4.25/4.21 and Rtl 2.20/3.45. During IPAP15/EPAP4, the Ruaw was 5.18/5.73, and the Rtl was 2.31/3.83. Ruaw was significantly higher than Rtl for inspiration at both IPAP levels (p = 0.001 and p = 0.012), and for expiration with IPAP15/EPAP4 (p = 0.048). The resistance appeared dynamic during the NIV cycle, and the findings aligned with the laryngoscopic observations. NIV modulates upper airway and translaryngeal resistance. Resistance increases with elevated IPAP levels, particularly within the upper airway.

BACKGROUND:Bronchiolitis is associated with asthma persisting until adulthood. While bronchial hyper-reactivity (BHR) is a hallmark of asthma, its occurrence and characteristics after bronchiolitis have been less studied. We aimed to study if BHR differed between young adults hospitalised for bronchiolitis in infancy and control subjects with no such history. Further, we sought to study whether any association between asthma and BHR differed between these two groups. METHODS:This Norwegian historical cohort study included 186 young adults hospitalised for respiratory syncytial virus positive or negative bronchiolitis in infancy during 1996-2001 and 139 matched control subjects. BHR was assessed at 17-20 years by methacholine provocation tests and recorded as dose-response slopes (DRS). Outcomes were analysed by mixed effects regression models. RESULTS:DRS was higher in the post-bronchiolitis group than in the control group (regression coefficient (β) 0.37; 95% CI 0.01 to 0.73; p=0.045). In both groups combined, current asthma was positively associated with DRS (β 0.98; 95% CI 0.50 to 1.45; p<0.001). Stratified analyses showed that the effect (β) of asthma on BHR was 0.80 (95% CI 0.21 to 1.38; p=0.008) in the post-bronchiolitis group and 1.40 (95% CI 0.58 to 2.23; p=0.001) in the control group. The difference in the association between asthma and BHR across the two groups was not statistically significant (p=0.191 for interaction). CONCLUSIONS:BHR at age 17-20 years was higher in subjects hospitalised for bronchiolitis in infancy than in control subjects. The association between asthma and BHR was not found to differ between the post-bronchiolitis group and the control group, although a possible stronger association in the control group may warrant further study.