Scientific Programme
Plenary Session
PS-PL03 - Understanding Breathlessness in Athletes
Date: 10.07.2026, Time: 16:45 - 18:00, Session Room: Auditorium A (STCC)
Description
There is accumulating evidence over the last 40 years that a healthy respiratory system can play a substantial limiting role in exercise performance in endurance athletes. There is at least one in four young athletes who experiences exercise-related respiratory problems, and approximately 15% of Olympic endurance athletes suffer from asthma and exercise-induced laryngeal obstruction (EILO). This plenary session aims to provide the ECSS community with a ‘state of the art’ update on the respiratory system limitation in elite endurance athletes and how to tackle respiratory problems in athletic individuals by world experts Profs. Jerome Dempsey and Hege Clemm. This session is very relevant to ECSS's vision of disseminating innovative science in sport, exercise, and health. It will target the broad ECSS community, including sport scientists, researchers, physiologists, and physiotherapists. The attendees of the congress will have a broad understanding of the pulmonary system responses during exercise and a comprehensive overview of respiratory limitations in elite athletes. They will become familiar with the best way to investigate pulmonary issues in athletes and the main differential diagnoses between asthma and EILO, and their clinical management in young athletes. The attendees will also improve their knowledge about the non-medicinal therapeutic options to optimise athlete respiratory care and how to help athletes with respiratory issues to safely engage in and enjoy sport.
Chair(s)
Azmy Faisal
Manchester Metropolitan University, Sport and Exercise Sciences
United Kingdom
Speaker A
Jerome Dempsey
University of Wisconsin-Madison, Population Health Sciences
United States
Read CVECSS Lausanne 2026: PS-PL03 [41453]
Is the athlete's respiratory system built to meet exercise demands?
The respiratory system as a limiting factor in exercise is presented as “overbuilt”- and therefore non-limiting- in most untrained healthy young adults… as opposed to “underbuilt” (and limiting) in many highly trained endurance-trained athletes. The overbuilt respiratory system in the young, untrained adult is characterised by a precise, highly mechanically efficient ventilatory response to exercise, a low resistance/low pressure pulmonary vasculature, and near-perfect gas exchange plus a fatigue-resistant respiratory musculature. The maximal demand for O2 transport in these subjects rarely, if ever, exceeds the maximal capacity of the lung, pulmonary vasculature, or respiratory muscles. On the other hand, as the demand for max O2 transport rises in the highly trained because of a highly adaptable cardiovascular system and locomotor muscle aerobic capacity, many elements in the endurance-trained athletes’ respiratory system have not adapted proportionally. Accordingly, maximal physiologic demands on the athletes’ respiratory system often exceed their capacity. For example, many highly trained athletes will experience expiratory flow limitation, excessive pulmonary arterial and capillary pressures, a failed alveolar to arterial gas exchange, and excessive work of breathing. In turn, these responses to exercise often elicit: a) arterial hypoxemia and reduced systemic O2 transport; b) accumulation of metabolites accompanied by fatigue in the diaphragm and expiratory muscles -triggering a metaboreflex- mediated sympathetic vasoconstriction and reduced blood flow to limb locomotor muscles; and c) excessive expiratory intrathoracic pressures leading to reduced diastolic filling and compromised max stroke volume and cardiac output. Experiments using small increments in inspired O2 to prevent exercise-induced arterial hypoxemia and assisted mechanical ventilation to reduce the work of breathing have demonstrated the significant effects of these respiratory limitations on locomotor muscle fatigue as well as on both max VO2 and endurance exercise performance. These performance limiting effects of high demands for gas transport exceeding respiratory system capacities in many highly trained athletes appear to be especially prevalent in the female athlete ( secondary to compromised airway diameters), during sojourn to even moderately high altitudes ( due to increased propensity for exercise-induced arterial hypoxemia), in the aging master athlete ( due to aging -induced reductions in lung elastic recoil and pulmonary vasculature compliance) and especially in the equine athlete( in whom their pulmonary vasculature and intra-and extrathoracic airways are substantially underbuilt to accept their extraordinary cardiac outputs and air flow velocities). Prof. Jerry Dempsey's distinguished discussion will excite the ECSS community, particularly sport scientists, physiologists, and early-career researchers, with his intriguing lifetime research.
Speaker B
Hege Clemm
Norwegian school of Sport Science, Department of Sports Medicine
Norway
Read CVECSS Lausanne 2026: PS-PL03 [19126]
Mysteries in The Breathless Athlete: Exercise-Induced Laryngeal Obstruction (EILO)
Exercise-induced Laryngeal Obstruction (EILO) is a recently recognised entity in which the larynx closes inappropriately on inspiration. Typically, the phenomenon occurs at high exercise intensity and at the supraglottic level, although glottic or combined closure can be seen. The prevalence rates of EILO in adolescent populations range from 5% to 8% and it can increase to more than 20% in elite athletes and combat soldiers. EILO deters people from participation in physical activities and sports and can, in severe cases, lead to exercise avoidance, impair performance, and affect sports careers in athletes. Clinically, patients with EILO often present in the asthma clinic, and some have been incorrectly treated for asthma for years. EILO is an important cause of upper airway dysfunction in young individuals and athletes, and can mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction. EILO is a highly prevalent cause of unexplained dyspnoea and wheeze in athletes. This complex phenomenon progresses relentlessly over time and it's effective treatment remains an elusive goal. Our understanding of the precise mechanisms of EILO will enable us to develop more effective therapeutic interventions and rehabilitation programmes for patients suffering from this phenomenon. Over the past two decades, there has been considerable progress in the recognition and assessment of EILO in sports medicine. The ‘gold standard’ to diagnose and categorise EILO in athletes is by means of continuous laryngoscopy performed during high-intensity exercise. This talk aims to provide a state-of-the-art overview of EILO and guidance for how to evaluate and treat suspected cases of EILO in young athletes. The talk will focus on the pathophysiology of EILO, outline a diagnostic approach, and present some of the most applied treatment strategies. The main motivation is to optimise athletes’ respiratory care through recognition of EILO, and specifically to improve the management of EILO, based on the available scientific evidence. This talk will target the entire ECSS community, particularly sports medicine physicians, physiologists, physiotherapists, sport scientists, and researchers. As a paediatric physician and clinical scientist, Prof. Hege Clemm will deliver key clinical take-home messages for the attendees: • EILO can affect people in all age groups – and on all sports levels. • EILO is as common as EIB • EILO can’t be treated with medications • EILO is different from asthma, but some may have both asthma and EILO • You need to look for EILO to see it • You can suspect EILO by symptoms, but laryngoscopy will help specifically diagnose and treat. • Treatment for dysfunctional breathing may help both people with asthma and EILO