Respiratory and real-time laryngeal dynamics in Exercise-Induced Paradoxical Vocal Fold Motion - Nationwide, over one million adults suffer from Exercise-Induced Laryngeal Obstruction (EILO) – also termed paradoxical vocal fold motion. EILO is a debilitating disorder characterized by inappropriate episodic adduction of the vocal folds and/or supraglottic structures during exercise, resulting in shortness of breath and/or loss of consciousness. Progress in the management of EILO is limited due to a lack of understanding of its pathophysiology. A significant gap is the lack of real-time pathophysiological data that captures dynamic upper airway changes during episodic EILO events in field settings. The current standard-of-care for EILO diagnosis requires continuous laryngoscopy during exercise; however, it is suboptimal, and unpredictable, with a 44% missed rate of EILO events. Hence, there is an urgent need for examination of EILO pathophysiology in real-time field-based settings. However, there are many unknowns about the causes and underlying pathophysiology of EILO that hinders development of effective treatments. There is consensus that the incidence of EILO peaks at higher ventilation levels during exercise; however, data supporting a pulmonary basis for EILO are lacking. Smaller upper airway size and associated changes in upper airway aerodynamics have been suggested as contributing factors, but their functional and clinical relevance for EILO remains unknown. To address these needs, this proposal leverages current advances in mechanical engineering, machine learning, exercise and respiratory physiology, as well as computational fluid dynamic modeling and medicine to provide quantitative predictive measures of EILO in realtime in field settings using a novel wireless mechano-acoustic device developed in our lab and delineate the biophysiological signatures of pulmonary abnormalities, size, and upper airway aerodynamics contributing to EILO in young adults. Our long-term goals are to determine the pathophysiology of EILO to enhance clinical assessment and establish efficacious treatments. Therefore, the specific aims of this application are to: 1) identify real-time physiological changes associated with EILO during exercise in field settings using an innovative, optimized wearable mechano-acoustic sensor developed in our lab, 2) identify the role of abnormal exercise ventilation and hypocapnia in laryngeal closure during symptomatic breathing in young adults with EILO, and 3) identify unique biophysiological factors of size and upper airway aerodynamics contributing to EILO among exercisers with and without EILO using magnetic resonance imaging and computation fluid dynamic modeling. A total of 120 young adults (60 with and 60 without EILO), 18-26 years of age, will be recruited to this study. The proposed research is significant in filling a crucial gap in our knowledge concerning the role of real-time pathophysiology from field-based monitoring in EILO and in yielding new insights into the pulmonary and biophysiological signatures of EILO. The fundamental knowledge from this research will have a significant clinical impact, benefiting both children and adults, and reducing the burden of illness caused by EILO.
