For athletes & active people

When your breathing can’t keep up with your training.

Exercise-related breathlessness (breathlessness during hard training or competition) has many possible causes, and they are routinely confused. A targeted, sport-specific work-up tells them apart, so you get the right diagnosis, not just inhalers that don’t work.

The three conditions

International athletes are welcome. Consultations can be held in English.

The clinic assesses and treats adults and adolescents. Patients under 18 are seen by prior agreement with the clinic.

Three conditions that are confused

They look alike from the outside, yet call for different answers.

EILO

Exercise-induced laryngeal obstruction

EILO is a transient narrowing in the larynx during hard exertion. It typically causes audible, laboured breathing in and breathlessness at peak effort, and is often mistaken for asthma. Getting the diagnosis right matters, because EILO needs a different approach: asthma medication rarely helps. EILO is one of Emil Ingerslev Walsted’s principal research areas, and he is a co-author of the joint European Respiratory Society and European Laryngological Society statement on inducible laryngeal obstruction.

Read about EILO EILO or asthma? Chronic cough: causes and assessment
  • Breathlessness at high intensity that eases quickly after stopping
  • Audible, laboured breathing in (stridor)
  • A feeling that the throat tightens
  • Little or no effect of asthma medication
EIB

Exercise-induced asthma (EIB)

Exercise-induced bronchoconstriction is a transient narrowing of the lower airways triggered by exertion. It is especially common in endurance, winter and swimming sports, where cold, dry or chlorinated air stresses the airways. We make the diagnosis objectively with a bronchial provocation or exercise test — including EVH (eucapnic voluntary hyperventilation) and an exercise challenge on a cycle ergometer, where the choice between them depends on the question and on you (the IOC highlights EVH for elite athletes) — since symptoms alone are unreliable, and we tailor treatment to your training volume, sport and competitive level.

Read about exercise-induced asthma

Which test? Mannitol, methacholine, EVH and exercise

  • Cough, wheeze or breathlessness during or after training
  • Symptoms worsen in cold or dry air, or when the weather changes
  • Symptoms vary from day to day
  • Reduced endurance compared with expected
Breathing pattern

Dysfunctional breathing

An unhelpful breathing pattern can itself cause breathlessness, dizziness, tingling and reduced performance, even when there is nothing wrong with the lungs. It is often mistaken for asthma. We assess your breathing pattern and guide breathing retraining, often together with a physiotherapist.

Read about dysfunctional breathing

  • Breathlessness that doesn’t match objective lung function
  • Irregular, rapid or upper-chest breathing
  • Dizziness, tingling in the fingers or frequent sighing
Three courses drawn over time. The vertical axis is the strength of the symptoms, the horizontal is time, and the marked band is the effort itself. In exercise-induced asthma the symptoms peak some minutes after the effort ends and settle over half an hour to an hour. In EILO they peak during the effort itself and ease within a few minutes of stopping. In dysfunctional breathing they follow no fixed course and can come before, during and after (or on a day with no exercise at all). Exercise-induced asthma Wheezing from the chest Effort Worst in the minutes after settles over half an hour to an hour EILO Audible, laboured breathing from the throat Effort Worst during the effort itself passes quickly once you stop Dysfunctional breathing Dizziness and tingling come with it Effort Follows no fixed course can come before, during and after Strength of symptoms Three courses drawn over time. The vertical axis is the strength of the symptoms, the horizontal is time, and the marked band is the effort itself. In exercise-induced asthma the symptoms peak some minutes after the effort ends and settle over half an hour to an hour. In EILO they peak during the effort itself and ease within a few minutes of stopping. In dysfunctional breathing they follow no fixed course and can come before, during and after (or on a day with no exercise at all). Exercise-induced asthma Wheezing from the chest Effort Worst in the minutes after settles over half an hour to an hour EILO Audible, laboured breathing from the throat Effort Worst during the effort itself passes quickly once you stop Dysfunctional breathing Dizziness and tingling come with it Effort Follows no fixed course can come before, during and after
The three conditions drawn over time. The vertical axis is the strength of the symptoms, the horizontal is time, and the marked band is the effort itself. The timing is what separates them best, together with the sound. The curves show the shape of the course, not measured values, and the three can occur together. Schematic drawing.

The right diagnosis

The diagnosis decides the treatment.

The three conditions look similar from the outside but each needs its own approach: EILO is managed with breathing and laryngeal muscle-control technique, EIB with targeted medication and warm-up, and dysfunctional breathing by retraining the breathing pattern. That is why we establish an objective diagnosis wherever possible rather than treating on suspicion.

Investigation for EILO

The diagnosis is based on a sport-specific assessment by a specialist with particular expertise in EILO and substantial personal experience with continuous laryngoscopy during exercise (CLE), the most reliable test for the condition. The clinic will establish CLE in the near future, so the larynx can be observed while you exert yourself and the diagnosis rests on what actually happens during effort rather than on symptoms alone.

Asthma medication & anti-doping

Several asthma medicines are covered by the anti-doping rules. We advise competitive athletes on correct use of inhaled medication, dose limits and the need for a therapeutic use exemption (TUE). The rules are updated annually, so we always work from the current WADA list and Anti Doping Danmark’s guidance. Binding exemption decisions are made by Anti Doping Danmark and your federation.

Read about asthma medication and anti-doping (TUE)

Lung function & performance

We assess whether your breathing limits your performance and what can be optimised. Your lung-function measurements are seen in the context of your training and sport, and you get concrete advice. We do not promise performance gains from treating healthy lungs. The aim is to remove what gets in the way.

How an athlete work-up is done

Built around your sport.

  1. Sport-specific history

    We map your sport, training load, when symptoms appear and what triggers them.

  2. Objective testing

    Lung function and, depending on the picture, targeted tests to tell the conditions apart.

    See the investigation programme

  3. Diagnosis & plan

    A clear diagnosis and a plan that fits your training and, for competitors, the anti-doping rules.

Record your breathing

A short audio or video recording of your breathing while you have symptoms, together with a description of your sport, training load and triggers, makes the diagnosis markedly easier. Bring it to your appointment.

Before your visit

Get to the bottom of it

A referral from your GP is normally required. Your GP sends it electronically, and it is then held ready for the clinic. You book a time yourself with MitID, and we collect the referral. You do not need to wait to hear from us.

You can also be seen without a referral as a private or insurance patient at the clinic’s rates.

See the prices without a referral