EILO Treatment: What New Research Tells Us About Breathing Retraining and Laryngeal Control Therapy

If exercise leaves you feeling like your throat suddenly closes, you can’t get enough air in, or your breathing becomes loud and strained, the problem may not be your lungs.

It could be exercise-induced laryngeal obstruction (EILO). EILO occurs when the larynx, or voice box, narrows during exercise. Symptoms often appear when exercise becomes intense and can include:

• Throat tightness

• Difficulty breathing in

• Shortness of breath

• Noisy breathing or a high-pitched sound when inhaling (stridor)

• A feeling that your throat is closing

  
  

EILO is particularly common in adolescents, young adults, and athletes. It can also be frustrating and frightening—especially when it interferes with a sport or activity you love.

An article published in October 2026, “Breathing Retraining and Laryngeal Control in Exercise-Induced Laryngeal Obstruction and Breathing Pattern Dysfunction: A Practical Therapy Model for Clinicians,” by Amrita Bonthua and Claudio F. Milstein, describes a structured behavioral therapy approach designed to help people gain better control over their breathing and larynx during exercise. We have started to implement this as part of our EILO protocol here at True Self Speech Therapy.

Here is what people considering therapy for EILO should know.

EILO Is Not the Same as Asthma

One reason EILO can go untreated is that its symptoms can resemble exercise-induced asthma.

But the two conditions affect different parts of the airway. Asthma involves the lower airway, while EILO occurs in the upper airway at the level of the larynx. That distinction matters because treatments intended for asthma, such as bronchodilators, do not treat EILO itself. The authors describe patients who had undergone extensive medical evaluations and tried multiple medications before the source of their breathing difficulty was identified.

For someone experiencing unexplained breathing problems during exercise, getting the correct diagnosis is an important first step.

How Is EILO Diagnosed?

The gold-standard diagnostic test described in the article is continuous laryngoscopy during exercise (CLE).

During a CLE test, a small flexible camera is positioned through the nose so clinicians can watch what happens to the larynx while a person exercises intensely enough to reproduce their symptoms. Why test during exercise? EILO can be difficult to identify at rest because the obstruction is temporary. Symptoms typically appear during intense exercise and then resolve quickly afterward. Looking at the larynx while the symptoms are actually happening gives clinicians important information about what is occurring.

Evaluation may also include pulmonary and cardiac testing because other causes of exercise-related breathing difficulty need to be considered.

EILO May Be Only Part of the Breathing Problem

One of the particularly interesting findings discussed by Bonthua and Milstein is the relationship between EILO and breathing pattern dysfunction (BPD).

BPD involves inefficient breathing mechanics. Someone may rely heavily on the upper chest, shoulders, neck, and other accessory muscles instead of using a more efficient lower-torso breathing pattern.

In previous research from the authors' group, approximately 78% of 78 patients referred for suspected EILO also met criteria for breathing pattern dysfunction. EILO and BPD are not the same condition, and either can occur independently. But they can also occur together.

That is one reason therapy may involve more than learning a single “rescue breath.” Treatment can address the person's overall breathing pattern as well as what happens at the larynx.

What Does EILO Therapy Look Like?

The treatment model described in the 2026 article is provided individually by a trained speech-language pathologist and uses principles of motor learning.

The goal is not simply to perform a breathing exercise correctly while sitting in a therapy room. The patient gradually learns to recognize inefficient breathing, correct it independently, and eventually use the new skills during the activities that actually trigger symptoms. Treatment begins with foundational breathing skills and progresses toward increasingly demanding activities.

1. Learning Lower-Torso or Abdominal Breathing

Patients learn to reduce excessive upper-chest, shoulder, and neck involvement while encouraging relaxed movement of the abdomen and lower rib cage.

Visual and tactile feedback may be used to help the patient recognize the difference between efficient breathing and their habitual breathing pattern.

This awareness is important. Ultimately, you need to be able to recognize when your old breathing pattern is returning and know how to change it.

2. Using Pursed-Lip Breathing as a Learning Tool

The authors use pursed-lip breathing during the learning stages to help patients gain greater control over airflow.

Importantly, this isn't necessarily how someone is expected to breathe forever.

In this treatment model, pursed-lip breathing serves as a temporary training strategy. As respiratory control improves, the goal is to return to more natural breathing.

3. Practicing Ratio Breathing

Breathing is then coordinated with specific rhythms or movements.

Practice progresses from relatively easy situations—such as lying down, sitting, and standing—to walking, jogging, and eventually more strenuous exercise.

This gradual progression is intentional. It gives patients an opportunity to maintain good breathing mechanics as the physical demands increase.

4. Learning What an “Open Throat” Feels Like

The therapy also incorporates reflexive release or open-throat strategies, including simulated yawning.

These exercises help patients experience the sensation of a relaxed, open larynx so they have a physical reference for what they are trying to reproduce when exercising.

Therapy Eventually Has to Look Like Real Life

Being able to breathe efficiently while lying on a treatment table is very different from maintaining that pattern while sprinting, swimming, wrestling, or competing.

For that reason, treatment progresses toward movement and eventually the situations that provoke the person's symptoms.

The protocol described by Bonthua and Milstein generally progresses through three to four individual sessions spaced one to two weeks apart, although treatment is individualized and additional sessions may be needed.

Early sessions establish breathing mechanics and self-monitoring. Later sessions incorporate walking and jogging, increased exercise intensity, symptom-management strategies, and—when appropriate—sport-specific practice.

For competitive athletes, therapy can even incorporate simulations of their sport and preperformance breathing routines.

An Important Part of Treatment: Learning to Coach Yourself

A major theme of this approach is self-monitoring.

Instead of depending indefinitely on a clinician to tell you whether every breath was “right” or “wrong,” you learn to notice what your body is doing.

For example:

Are my shoulders rising?

Am I tightening my neck?

Where do I feel the breath moving?

Does my throat feel relaxed or tight?

What changed when the exercise became harder?

As skills improve, the clinician deliberately provides less feedback. The goal is for the patient to recognize a problem and make an adjustment independently. That is particularly important with EILO because the moment when you most need these skills is likely to occur outside the therapy room and during exercise.

Practice Between Sessions Matters

The treatment described in the article includes daily home practice. After the first session, patients are encouraged to complete 10–20 minutes of structured exercises and perform brief breathing checks during the day. As treatment progresses, practice becomes more active and begins incorporating the situations that are relevant to the individual.

Parents, caregivers, or coaches may also participate when appropriate. Rather than constantly reminding someone to “breathe correctly,” they can learn to recognize specific behaviors, such as shoulder elevation or excessive upper-chest movement, and provide targeted feedback.

Does EILO Therapy Work?

The results reported by this clinical group are encouraging, but they also need to be interpreted appropriately.

In an earlier evaluation of their protocol involving a chart review of 88 patients and a prospective questionnaire-based survey, Dyspnea Index scores improved significantly following treatment. Among surveyed patients, 93.3% reported improvement, and 53.3% said their symptoms were “a lot better.”

The 2026 article also describes a 17-year-old wrestler who had stopped competing because of his breathing symptoms. Following treatment targeting both EILO and breathing pattern dysfunction, he returned to competitive wrestling and remained symptom-free at three-month follow-up.

These findings do not, however, mean that every person with EILO will respond the same way.

The authors specifically acknowledge that their protocol has not been tested in a randomized controlled trial, has not been formally validated or approved by a professional regulatory body, and has not been directly compared with other EILO treatment approaches. Other behavioral treatment frameworks for EILO also exist.

So the research supports breathing retraining and laryngeal control as promising behavioral approaches, but we do not yet have evidence establishing one specific protocol as the best treatment for everyone with EILO.

What If Breathing Therapy Doesn't Completely Resolve the Symptoms?

This may be one of the most clinically useful messages from the article. Therapy shouldn't simply continue indefinitely if you have learned the techniques, can perform them correctly, and still have significant symptoms.

The authors describe a 15-year-old competitive swimmer who mastered her breathing and laryngeal control techniques but continued to experience stridor and shortness of breath during high-intensity swimming.

That discrepancy prompted further investigation. Her clinicians ultimately determined that an anatomical issue was contributing to her persistent symptoms, and she required additional medical treatment.

In other words, lack of improvement doesn't necessarily mean that you aren't trying hard enough or performing the techniques incorrectly. Persistent symptoms despite good technique may be a reason for your treatment team to reconsider whether something else is contributing to the problem.

What Should You Expect From EILO Therapy?

Good EILO treatment is highly individualized.

At True Self Speech Therapy, we are speech-language pathologists trained in respiratory retraining. We evaluate how you breathe at rest and during increasing levels of activity, teach strategies for improving respiratory and laryngeal control, and then help you carry those skills into progressively more challenging situations.

For an athlete, the ultimate goal isn't to become excellent at breathing exercises.

It is to be able to run, swim, wrestle, play, perform, or exercise with greater respiratory control—and to know what to do when you begin to feel your symptoms developing.

The 2026 research from Bonthua and Milstein reinforces an important idea: EILO therapy is not simply about learning a trick to “open your throat.” It is a progressive process involving breathing mechanics, laryngeal control, self-awareness, motor learning, and—most importantly—carrying those skills into the situations where you actually need them.

If exercise-related throat tightness, noisy inhalation, or sudden difficulty getting air in is keeping you from participating fully in exercise or sport, an evaluation for EILO and treatment with a clinician experienced in EILO, breathing retraining, and laryngeal control therapy may help determine what is happening and what treatment approach is appropriate for you.

This article is educational and is not a substitute for individualized medical evaluation. Exercise-related breathing difficulty can have multiple causes, and appropriate medical assessment is important before assuming symptoms are caused by EILO.

Source: Bonthua, A., & Milstein, C. F. (2026). Breathing Retraining and Laryngeal Control in Exercise-Induced Laryngeal Obstruction and Breathing Pattern Dysfunction: A Practical Therapy Model for Clinicians.