When Breathing Feels Hard—but Asthma Isn’t the Answer

Understanding Paradoxical Vocal Dysfunction (EILO) and How Speech Therapy Can Help

If you or your child feel short of breath during exercise, sports, or even everyday activities—and asthma treatments haven’t helped—you’re not alone. Many people are told they have asthma, use inhalers faithfully, and still struggle to breathe. For a large number of these individuals, the real issue isn’t the lungs at all—it’s the voice box.

At True Self Speech Therapy, we specialize in treating paradoxical vocal dysfunction, also known as exercise-induced laryngeal obstruction (EILO), using a whole-person, speech-language pathology–based approach that addresses breathing, the body, and the mind together.

What Is Paradoxical Vocal Dysfunction / EILO?

Paradoxical vocal dysfunction occurs when the vocal folds or surrounding structures close instead of open during breathing in, especially during physical exertion. This can cause:

• Sudden shortness of breath

• A feeling of “breathing through a straw”

• Throat tightness or choking sensations

• Noisy breathing or stridor

• Panic or fear during exercise

  
  

Unlike asthma—which affects the lower airways—EILO affects the upper airway at the level of the larynx. Because symptoms can look similar, many people are initially misdiagnosed with asthma.

Why Asthma Treatment Often Doesn’t Help

Research consistently shows that a high percentage of people with EILO are prescribed inhalers but experience little or no relief. In the study you shared, over 80% of patients reported that inhalers did not improve their symptoms.

That’s because:

• EILO is not caused by airway inflammation

• Medications designed for asthma don’t change how the vocal folds move

• The problem is functional—not structural or inflammatory

  
  

This can be incredibly frustrating and frightening for patients and families, especially when symptoms persist for years before the correct diagnosis is made.

A Whole-Person Approach to Breathing

Recent research (study at the link at the end of this post) from the our neighbor in Massachusetts- the Speech and Voice Therapy Center, strongly supports a holistic speech-language pathology approach to treating EILO.

They endorse using the P.I.E. approach:

P — Physical

• Manual therapy to release tension in the neck, throat, and breathing muscles

• Retraining breathing patterns to be slow, nasal, efficient, and calm

• Gradual progression from breathing at rest → walking → sport-specific exertion

• Practicing breathing in real-world conditions, not just in the clinic

  
  

I — Intellectual (Cognitive)

• Education about how breathing works

• Understanding the connection between breathing sensations and performance

• Building confidence and control over breathing during exertion

  
  

E — Emotional

• Addressing stress, anxiety, and fear around breathing

• Recognizing how emotions influence breathing patterns

• Teaching mindfulness and self-monitoring strategies

  
  

This approach acknowledges what many patients already feel: breathing difficulties are physical, emotional, and cognitive all at once. It also validate what we already do here at True Self Speech therapy. We've focused on not only the physical, but always address the emotional components and provide significant education throughout our sessions.

What the Research Shows

In this large retrospective study of 84 patients ranging from children to adults, the results were striking:

• Nearly all patients showed clinically meaningful improvement

• Breathing symptoms decreased into the normal range on validated outcome measures

• Improvements occurred whether therapy was delivered:

  • Intensively over a short time

  • Weekly over several months

• Patients who had failed previous treatments—including inhalers and prior breathing handouts—responded positively

  
  

Importantly, improvements weren’t limited to sports. Patients reported better breathing during:

• School and work

• Studying and presentations

• Daily life activities

  
  

Why Speech-Language Pathologists Are Key

Speech-language pathologists are uniquely trained to treat conditions involving the larynx, breathing coordination, and functional movement patterns. Treating EILO is well within our scope and when done holistically, it can be life-changing.

At True Self Speech Therapy, we don’t just teach breathing exercises. We help patients:

• Rebuild trust in their body

• Learn to breathe efficiently under stress

• Transfer skills from the clinic into real life

• Feel confident returning to activity

  
  

You Don’t Have to “Push Through” Breathing Symptoms

If you or your child:

• Have been told you have asthma but treatments haven’t helped

• Feel panicked or tight in the throat during exercise

• Avoid activities because breathing feels scary or unpredictable

  
  

There is another explanation—and effective, evidence-based treatment is available.

How We Can Help at True Self Speech Therapy

We specialize in holistic treatment for paradoxical vocal dysfunction and EILO, offering individualized care that addresses the whole person, not just symptoms.

📍 In-person services available in Rhode Island 💻 Secure teletherapy options available when appropriate

If breathing has been limiting your life, we’re here to help you feel safe, strong, and confident again.

Reach out today to schedule an evaluation or learn more about our approach.

Reference: https://pubs.asha.org/doi/pdf/10.1044/2025_PERSP-25-00038