Hege Clemm

• Andersen, Tiina Maarit; Brekka, Anne Kristine; Ntoumenopoulos, George; Rogde, Åse Johnsen; Clemm, Hege Synnøve Havstad & Halvorsen, Thomas [Show all 8 contributors for this article] (2026). Can laryngeal ultrasound detect laryngeal movements during mechanically assisted cough? European Respiratory Journal Open Research (ERJ Open Research). 12(5). doi: 10.1183/23120541.00324-2026. Full text in Research Archive Show summary

  Background: Mechanical insufflation–exsufflation (MI-E) is used to augment ineffective cough, but treatment efficacy depends on appropriate upper airway response. Transnasal flexible laryngoscopy (TFL) is the reference standard for assessing laryngeal responses, but is invasive. This study evaluated whether laryngeal ultrasonography (US) can assess laryngeal responses during MI-E. Methods: In this cross-sectional study, healthy volunteers underwent MI-E with both passive and active cough efforts, while TFL and US were performed simultaneously. Laryngeal US was applied using anterior and lateral approaches. Recordings were analysed retrospectively frame-by-frame by two blinded raters. Assessability was defined as appropriate visualisation of the vocal folds or aryepiglottic folds. Visualisation success rates and concordance between laryngeal US and TFL findings were calculated across pre-specified MI-E cycles. Inter-rater reliability for US interpretation was assessed in a subset. Results: 30 adult participants and 875 MI-E cycles were included. At least one laryngeal US approach yielded assessable data in all participants, with lower assessability in males. Across MI-E cycles, visualisation success rates were higher for TFL than for laryngeal US (93.5% versus 68%). Concordance between US and TFL was 78% and 79% during passive and active insufflation, 80% and 88% during passive and active exsufflation, and 92% during active cough compression. Inter-rater reliability was substantial (κ=0.62). Conclusion: This exploratory study suggests that laryngeal US may offer a feasible noninvasive approach to assess laryngeal responses during MI-E, but TFL remains the reference standard. Further validation in patient populations is required.

• Haakstad, Lene Annette Hagen; Bø, Kari; Kalhovde, John Magne; Tangen, Elene Mauseth; Clemm, Hege Synnøve Havstad & Gjestvang, Christina (2026). Varying In-Person Coaching: Effects on Weight and Urinary Incontinence in Women with Obesity in a 20-Week Randomized Controlled Trial. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-026-06862-7. Full text in Research Archive
• Brekka, Anne Kristine; Solli, Petrine Veierød; Indrekvam, Solfrid; Engeset, Merete Salveson; Røksund, Ola Drange & Lehmann, Sverre [Show all 12 contributors for this article] (2026). Laryngeal Responses During Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease: An Observational Study. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 21, p. 1–11. doi: 10.2147/COPD.S596874. Full text in Research Archive Show summary

  Purpose: Long-term non-invasive ventilation (NIV) is an established therapy for hypercapnic chronic obstructive pulmonary disease (COPD); however, many patients remain challenging to ventilate effectively. We hypothesized that NIV-induced laryngeal obstruction (NIV-ILO), observed during laryngoscopy, may contribute to reduced ventilatory effectiveness, and that this obstruction can be identified using laryngeal ultrasound (US). Patients and Methods: This exploratory cross-sectional study included 15 participants with stable COPD receiving long-term NIV. Laryngeal responses were assessed using transnasal flexible laryngoscopy (TFL) and US. Assessments began during spontaneous breathing, followed by NIV at each participant’s prescribed settings. Inspiratory positive airway pressure (IPAP) was increased in 2 cmH2O increments to the device’s maximum. Laryngeal responses were assessed in real time and reassessed retrospectively from video recordings. The participants rated discomfort using a numeric rating scale (0– 10). Results: Fifteen participants (40% female) were included. The prescribed IPAP ranged from 7 to 30 cmH2O, with NIV-ILO observed in 5 of 15 participants at a median of 22.0 cmH2O. During subsequent pressure increments, additional 6 of 15 developed NIV-ILO at a median (range) IPAP of 20.5 cmH2O (16.0– 30.0), yielding 11 participants (73.3%) developing NIV-ILO within the pressure range of their device. US was assessable in 11 participants, with the structures of interest visualized during 54 of 63 pressure increments. The two methods demonstrated complete concordance for all assessable findings. Conclusion: NIV-ILO was common in patients with COPD using long-term NIV, occurring within the pressure range typically applied to achieve effective ventilation. US can serve as a less invasive diagnostic alternative to TFL.

• Sandvik, Lorentz; Veseth, Sivert Helland; Kvidaland, Haakon Kristian; Aarstad, Hans Jørgen; Carlsen, Petter Helø & Clemm, Hege Synnøve Havstad [Show all 14 contributors for this article] (2026). Exercise-Induced Laryngeal Obstruction: A Randomized Controlled Trial of Surgical Treatment. The Laryngoscope. ISSN 0023-852X. p. 1–8. doi: 10.1002/lary.70820. Full text in Research Archive Show summary

  Objective: Surgery is used to treat exercise-induced laryngeal obstruction (EILO), but high-quality evidence remains limited. We therefore conducted a surgical randomized controlled trial (RCT) evaluating full supraglottoplasty (FSP), minimally invasive supraglottoplasty (MISP), and a wait-and-see control group. Methods: Patients with symptomatic supraglottic EILO despite conservative management were randomized to FSP, MISP, or control. FSP involved aryepiglottic fold incisions including the tip of the cuneiform tubercle, whereas MISP included six laser punctures in the aryepiglottic folds. Continuous laryngoscopy during exercise (CLE) was performed before and after interventions. Laryngeal obstruction was graded at glottic and supraglottic levels during moderate and maximal exercise (CLE scores). Breathing problems were assessed using patient-reported outcome measure (PROM). Results: Forty-one patients were randomized to FSP (n = 13), MISP (n = 15), or control (n = 13). Between-group comparisons showed that FSP was superior to controls regarding supraglottic CLE scores at moderate intensity (p = 0.036), glottic and supraglottic CLE scores at maximum intensity (p = 0.047 and p < 0.001, respectively). FSP was also superior to MISP for supraglottic CLE scores at maximal intensity (p < 0.001). MISP did not differ from controls for any CLE outcomes. FSP reduced PROM for general breathing difficulties compared to controls (p < 0.001), and MISP (p = 0.042); both FSP and MISP reduced breathing-related PROM during activity (p = 0.039 and p = 0.022, respectively), without corresponding improvements in CLE outcomes for MISP. Conclusion: In patients with supraglottic EILO refractory to conservative management, FSP improved both CLE scores and patient-reported outcomes. These findings provide support for FSP in carefully selected patients considered for surgical treatment, while the role of MISP remains uncertain.

• Saeed, Sahrai; Carlsen, Petter; Muralitharan, Praveen; Solli, Petrine Veierød; Kvidaland, Haakon Kristian & Vollsæter, Maria [Show all 8 contributors for this article] (2026). Prevalence and clinical significance of T-wave inversion on electrocardiogram in patients with exercise-induced laryngeal obstruction (EILO): A cross-sectional study. Journal of Electrocardiology. ISSN 0022-0736. 96, p. 1–7. doi: 10.1016/j.jelectrocard.2026.154261. Full text in Research Archive Show summary

  Aims We aimed to systematically evaluate standard 12‑lead electrocardiograms (ECG) in young individuals with exercise-induced laryngeal obstruction (EILO), with a special focus on the prevalence and clinical significance of T-wave inversion (TWI). Methods and results 235 individuals (mean age 16.7 years, 85% females) presenting to the EILO Clinic, underwent 709 high-intensity cardiopulmonary exercise treadmill testing with continuous visualization of the larynx (CLE- Continuous Laryngoscopy Exercise). There was no adverse event during exercise tests. The prevalence of TWI (negatively deflected T-wave ≥1 mm (0.1 mV amplitude) in any 2 contiguous leads excluding aVR, III, and V1) was 42.6% (18.7% isolated in the inferior wall leads, 13.2% in the inferolateral leads, 5.1% in both the inferior and anterior leads, 3% both in the inferior and anteroseptal leads, 2.1% isolated in anteroseptal leads and 0.9% isolated in anterior wall leads). Age, body height and weight, exercise duration and peak oxygen uptake did not differ between individuals with versus without TWI (all p > 0.05). There was a trend towards lower total CLE score in individuals with TWI (4.2 vs 4.5, p = 0.070). Individuals with TWI had higher resting heart rate (98 vs 95 bpm, p = 0.05), shorter PQ-interval (124 vs 129 ms, p = 0.020) and achieved higher peak heart rate (193 vs 189 bpm, p = 0.005) and metabolic equivalents during exercise (13.4 vs 12.9, p = 0.028). Conclusions High-intensity CLE-test in individuals with EILO was not associated with any adverse cardiac findings. TWI was highly prevalent and particularly observed in the inferior or inferolateral wall leads but had no association with energetic decline or cardiac dysfunction.

• Morland, Nicolay; Tovi, David; Clarsen, Benjamin Matthew; Rygh, Cecilie Brekke; Bache-Mathiesen, Lena Kristin & Clemm, Hege Synnøve Havstad [Show all 7 contributors for this article] (2026). Incidence and risk factors of spondylolysis in youth football: a longitudinal study among male Norwegian players. BMJ Open sport & exercise medicine. 12(2), p. 003222–003222. doi: 10.1136/bmjsem-2026-003222. Full text in Research Archive Show summary

  Objectives Spondylolysis is a common source of low back pain (LBP) among adolescent athletes. We aimed to investigate the occurrence of LBP and spondylolysis, and the potential associations of weekly training and match exposure, and maturity status with spondylolysis among male youth football players. Methods Male players (n=98) from six teams were followed over three consecutive seasons (U15–U17). Training and match exposure (min), and pain/injuries were self-reported weekly. Clinical examinations were conducted if a player reported LBP and abstained from football training/matches for 1 week or reported LBP for 4 consecutive weeks despite participating. MRI was used to determine if the LBP was due to spondylolysis. The maturity level was estimated biannually by X-ray of the left hand, along with body height and weight. Risk factor analyses estimated the association between an increase in total weekly training and match exposure and the risk of spondylolysis, and between maturity factors and the risk of spondylolysis. Results Of 98 players, 46 reported back pain at least once, 18 fulfilled the criteria for a clinical examination and 13 underwent an MRI scan, identifying 12 cases of spondylolysis. Risk factor analyses showed a significant association between increased total weekly training and match exposure and the risk of spondylolysis. No association was shown between any maturity measure and the occurrence of spondylolysis. Conclusion Increased training and match exposure in the weeks before injury was significantly related to a diagnosis of spondylolysis. Maturity measures were not related to increased risk.

• Brekka, Anne Kristine; Vollsæter, Maria; Fretheim-Kelly, Zoe; Lujan, Manel; Nilsen, Roy Miodini & Clemm, Hege Synnøve Havstad [Show all 11 contributors for this article] (2025). Exploring upper airway and laryngeal resistance to noninvasive ventilation in healthy awake adults. Physiological Reports. 13(20), p. 1–10. doi: 10.14814/phy2.70621. Full text in Research Archive Show summary

  The interaction between anatomical structures, pressure, and airflow impacts the airway resistance. The airflow during noninvasive ventilation (NIV) relies on the upper airway and laryngeal patency. This study aimed to quantify the airflow resistance at these levels during NIV. In this cross‐sectional study examining 10 healthy, awake adults, we established a NIV setup incorporating a continuous video‐recorded transnasal laryngoscopy and simultaneous airway pressure measurement using a transducer positioned above and below the vocal folds. Airflow and mask pressure were recorded by a pneumotachograph at the mask. NIV was delivered with inspiratory positive pressure (IPAP)/expiratory positive pressure (EPAP) set to 10/4 and 15/4 cmH 2 O. Upper airway (R uaw ) and translaryngeal (R tl ) resistance were calculated and compared with laryngoscopic findings. During IPAP10/EPAP4, the R uaw was 4.25/4.21 and R tl 2.20/3.45. During IPAP15/EPAP4, the R uaw was 5.18/5.73, and the R tl was 2.31/3.83. R uaw was significantly higher than R tl for inspiration at both IPAP levels ( p  = 0.001 and p  = 0.012), and for expiration with IPAP15/EPAP4 ( p  = 0.048). The resistance appeared dynamic during the NIV cycle, and the findings aligned with the laryngoscopic observations. NIV modulates upper airway and translaryngeal resistance. Resistance increases with elevated IPAP levels, particularly within the upper airway.

• Mæstad, Rune; Hanan, Abdul; Kvidaland, Haakon Kristian; Clemm, Hege Synnøve Havstad & Arghandeh, Reza (2025). LarynxFormer: a transformer-based framework for processing and segmenting laryngeal images. Frontiers in Digital Health. 7. doi: 10.3389/fdgth.2025.1459136. Full text in Research Archive Show summary

  Manual diagnostic methods for assessing exercise-induced laryngeal obstruction (EILO) contain human bias and can lead to subjective decisions. Several studies have proposed machine learning methods for segmenting laryngeal structures to automate and make diagnostic outcomes more objective. Four state-of-the-art models for laryngeal image segmentation are implemented, trained, and compared using our pre-processed dataset containing laryngeal images derived from continuous laryngoscopy exercise-test (CLE-test) data. These models include both convolutional-based and transformer-based methods. We propose a new framework called LarynxFormer, consisting of a pre-processing pipeline, transformer-based segmentation, and post-processing of laryngeal images. This study contributes to the investigation of using machine learning as a diagnostic tool for EILO. Furthermore, we show that a transformer-based approach for larynx segmentation outperforms conventional state-of-the-art image segmentation methods in terms of performance metrics and computational speed, demonstrating up to 2x faster inference time compared to the other methods.

• Gjestvang, Christina; Kalhovde, John Magne; Tangen, Elene Mauseth; Clemm, Hege Synnøve Havstad & Haakstad, Lene Annette Hagen (2025). Impact of In-Person and Mobile Exercise Coaching on Psychosocial Factors Affecting Exercise Adherence in Inactive Women With Obesity: 20-Week Randomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 27. doi: 10.2196/68462. Full text in Research Archive Show summary

  Background: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity. Objective: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m2). Methods: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m2) were allocated into 3 groups of in-person coaching—weekly (n=47), twice weekly (n=47), and once monthly (n=47)—and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Results: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater “change in health last year” than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30). Conclusions: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research. Trial Registration: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657 J Med Internet Res 2025;27:e68462

• Vreim, Kristine; Karlsen, Tom; Carlsen, Petter; Nistad, Valgjerd Helene; Røksund, Ola Drange & Halvorsen, Thomas [Show all 10 contributors for this article] (2025). Speech therapy for exercise-induced laryngeal obstruction. European Archives of Oto-Rhino-Laryngology. ISSN 0937-4477. 282, p. 1345–1354. doi: 10.1007/s00405-024-09190-y. Full text in Research Archive Show summary

  Introduction: Exercise- Induced Laryngeal Obstruction (EILO) can lead to disabling exercise related dyspnea and hamper participation in physical activity. In this study, we aimed to investigate the effects of a standardized speech therapy protocol as treatment for EILO. Methods: Patients diagnosed with EILO at our institution were invited to participate. We compared laryngeal findings obtained during a continuous laryngoscopy exercise (CLE) test and questionnaire based self-reported breathing symptoms, before vs. after the treatment intervention. The laryngeal obstruction was characterized using a standardized CLE scoring system (0–12 points). Results: A total of 28 patients were evaluated. Following speech therapy, the mean reduction in the CLE score was 1.5 (95% confidence interval: 1.1–2.0) points, with the improvement primarily associated with decreased glottic-level obstruction. Twenty-four (86%) patients reported reduced symptoms during exercise. A moderate correlation was observed between changes in CLE scores and subjective symptom improvements. Conclusion: This study suggests that a standardized speech therapy protocol reduces observed laryngeal obstruction during the CLE test, with the most notable improvement occurring at the glottic level, alongside a parallel reduction in self-reported symptoms of EILO.

• Andersen, Tiina Maarit; Brekka, Anne Kristine; Fretheim-Kelly, Zoe; Lujan, Manel; Heimdal, John-Helge & Clemm, Hege Synnøve Havstad [Show all 11 contributors for this article] (2025). Upper Airway and Translaryngeal Resistance During Mechanical Insufflation-Exsufflation. Chest. ISSN 0012-3692. 167(1), p. 188–201. doi: 10.1016/j.chest.2024.08.022. Full text in Research Archive Show summary

  Background: Mechanical insufflation-exsufflation (MI-E) uses positive and negative pressures to assist weak cough and to help clear airway secretions. Laryngeal visualization during MI-E has revealed that inappropriate upper airway responses can impede its efficacy. However, the dynamics of pressure transmission in the upper airways during MI-E are unclear, as are the relationships among anatomic structure, pressure, and airflow. Research Question: Can airflow resistance through the upper airway and the larynx feasibly be calculated during MI-E, and if so, how are the pressures transmitted to the trachea? Study Design and Methods: Cross-sectional study of 10 healthy adults, where MI-E was provided with and without active cough using pressure settings +20/–40 cm H2O and ± 40 cm H2O. Airflow and pressure at the level of the facemask were measured using a pneumotachograph, whereas pressure transducers (positioned via transnasal fiber-optic laryngoscopy) recorded pressures above the larynx and within the trachea. Upper airway resistance (Ruaw) and translaryngeal resistance (Rtl) were calculated (in centimeters of water per liter per second) and were compared with direct observations via laryngoscopy. Results: Positive pressures reached the trachea effectively, whereas negative tracheal pressures during exsufflation were approximately one-half of the intended settings. Insufflation pressure increased slightly when passing through the larynx. Participant effort influenced tracheal pressures and the resistances, with findings consistent with laryngoscopic observations. During MI-E, resistance seems to be dynamic, with Ruaw exceeding Rtl. Inappropriate laryngeal closure increased Rtl during both positive and negative pressures. Interpretation: We found that Ruaw and Rtl can be calculated feasibly during MI-E. The findings indicate different transmission dynamics for positive and negative pressures and that resistances are influenced by participant effort. The findings support using lower insufflation pressures and higher negative pressures in clinical practice.

• Carlsen, Petter; Muralitharan, Praveen; Fenne, Hilde; Jansrud, Ida; Engan, Mette & Vollsæter, Maria [Show all 10 contributors for this article] (2024). Laryngeal response to high-intensity exercise in healthy athletes. BMJ Open sport & exercise medicine. 10. doi: 10.1136/bmjsem-2023-001850. Full text in Research Archive Show summary

  Introduction Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems. The current diagnostic approach rests on evaluation of laryngeal obstruction visualised by laryngoscopy performed continuously throughout a maximal exercise test (continuous laryngoscopy exercise (CLE) test) in patients who present with compatible symptoms. Laryngeal responses to high-intensity exercise in endurance athletes are not well described, potentially leading to inaccurate reference values and increasing the risk of misdiagnosing EILO. Aim To investigate laryngeal responses to high-intensity exercise in a healthy population of endurance athletes with no self-reported perception of respiratory problems. Methods A cross-sectional study was conducted at Haukeland University Hospital, Bergen, Norway, inviting amateur and professional athletes with no self-reported breathing problems who performed endurance training minimum four sessions weekly. Thirty-six eligible athletes completed a questionnaire detailing exercise habits and past and current respiratory symptoms. They performed a standardised CLE test from which cardiopulmonary exercise data and corresponding laryngeal responses were recorded. The CLE tests were evaluated in retrospect by two independent raters according to preset criteria providing a CLE score. The CLE score rates the severity of laryngeal obstruction during moderate and maximum exercise on the glottic and supraglottic regions on a scale ranging from 0 (no obstruction) to 3 (maximum obstruction). Results Twenty-nine (81%) athletes (15 females) aged 15–35 years completed a CLE test. Ten participants (33%) had a supraglottic CLE subscore of 2 or 3. Among these, two also had a glottic CLE subscore of 2 or 3. Notably, none had isolated glottic obstruction. Conclusion In healthy well-trained endurance athletes with no prior perception of respiratory symptoms, the laryngeal response to high-intensity exercise was diverse. Supraglottic laryngeal obstruction was observed in one-third of the athletes. The findings underline that a diagnosis of EILO should rest on observed laryngeal obstruction supported by compatible symptoms.

• Lillebøe, Henriette Lahn-Johannessen; Engeseth, Merete Salveson; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas; Røksund, Ola Drange & Potrebny, Thomas [Show all 7 contributors for this article] (2024). Expiratory airflow limitation in adults born extremely preterm: A systematic review and meta-analysis. Paediatric Respiratory Reviews. ISSN 1526-0542. 50, p. 2–22. doi: 10.1016/j.prrv.2024.02.002. Full text in Research Archive Show summary

  Extreme preterm (EP) birth, denoting delivery before the onset of the third trimester, interrupts intrauterine development and causes significant early-life pulmonary trauma, thereby posing a lifelong risk to respiratory health. We conducted a systematic review and meta-analysis to investigate adult lung function following EP birth (gestational age <28 weeks); comparing forced expiratory volume in first second (FEV1), forced vital capacity (FVC), and FEV1/FVC to reference values. Subgroup differences were explored based on timing of birth relative to surfactant use (1991) and bronchopulmonary dysplasia (BPD) status. Systematic searches were performed in Medline, EMBASE, Web of Science and Cochrane Central. Quality assessments were carried out using a modified Newcastle-Ottawa Scale for cohort studies. Sixteen studies encompassing 1036 EP-born adults were included, with 14 studies (n = 787) reporting data as %predicted, and 11 (n = 879) as z-score (not mutually exclusive). Overall mean [95 % confidence interval (CI)] %FEV1 was 85.30 (82.51; 88.09), %FVC was 94.33 (91.74; 96.91), and FEV1/FVC was 79.54 (77.71 to 81.38), all three with high heterogeneity. Overall mean (95 %CI) zFEV1 was −1.05 (-1.21; −0.90) and zFVC was. −0.45 (-0.59; −0.31), both with moderate heterogeneity. Subgroup analyses revealed no difference in FEV1 before versus after widespread use of surfactant, but more impairments after neonatal BPD. This meta-analysis revealed significant airflow limitation in EP-born adults, mostly explained by those with neonatal BPD. FEV1 was more reduced than FVC, and FEV1/FVC was at the lower limit of normal. Although at a group level, most adult EP-born individuals do not meet COPD criteria, these findings are concerning.

• Mæstad, Rune; Kvidaland, Haakon Kristian; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange & Arghandeh, Reza (2024). Diagnostics of Exercise-Induced Laryngeal Obstruction Using Machine Learning: A Narrative Review. Electronics (Basel). 13(10). doi: 10.3390/electronics13101880. Full text in Research Archive Show summary

  Objective: This paper explores machine learning methods for exercise-induced laryngeal obstruction (EILO) diagnostics. Traditional diagnostic approaches like CLE scoring face subjectivity, limiting precise objective assessments. Machine learning is introduced as a theoretical solution to potentially overcome these limitations and improve diagnostic precision. Methods: A narrative review was conducted to explore the integration of machine learning techniques in the diagnostics of EILO. Result: Three machine learning methods for the segmentation of laryngeal images were discovered: fully convolutional network, Mask R-CNN, and 3D VOSNet. Our findings reveal that the integration of machine learning with EILO diagnostics remains a largely untapped research domain, providing significant room for further exploration. Conclusions: The integration of ML techniques for EILO diagnostics has the potential to be a helpful tool for clinicians. The application of computer vision ML methods, such as image segmentation, to delineate laryngeal structures paves the way for a more objective assessment. While challenges persist, especially in differences in patients’ laryngeal anatomy, the synergy of ML and medical expertise is an important field to explore in the years to come.

• Karlsen, Tom Hemming; Vreim, Kristine; Røksund, Ola Drange; Vollsæter, Maria; Muralitharan, Praveen & Ellingsen, Thor Andre [Show all 9 contributors for this article] (2024). A speech therapy treatment protocol for exercise induced laryngeal obstruction. Frontiers in Pediatrics. 12. doi: 10.3389/fped.2024.1356476. Full text in Research Archive Show summary

  Background: Exercise induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young individuals, relevant to 5%–7% of young people. It is caused by paradoxical inspiratory adduction of laryngeal structures and diagnosed by continuous visualization of the larynx during high intensity exercise. Empirical data suggest that EILO consists of different subtypes that require different therapeutic approaches. Currently applied treatment approaches do not rest on randomized controlled trials (RCTs), and thus evidence-based guidelines cannot be established. This protocol describes the speech therapy treatment approach which is applied to EILO patients in a large prospective RCT called HelpILO. Methods and analysis: Consenting patients consecutively diagnosed with EILO at Haukeland University Hospital are randomized into four treatment arms. Speech therapy is represented in two of these, provided in a structured manner based on general speech therapy principles and abdominal breathing, combined with experience obtained with these patients at our hospital during the last decades. The main outcome measure of HelpILO is changes of laryngoscopically visualized laryngeal adduction, rated at peak exercise before vs. after interventions, using a validated scoring system. Ethics and dissemination: Despite widespread use of speech therapy in patients with EILO, this approach is insufficiently tested in RCTs, and the study is therefore considered ethically appropriate. The study will provide knowledge listed as a priority in a recent statement issued by major respiratory and laryngological societies and requested by clinicians and researchers engaged in this area. The results will be presented at relevant conferences, patient fora, and media platforms, and published in relevant peer reviewed international journals.

• Christen, Aspen; O'Connell, Amy; Mayer, Ivonne; Tona, Gabriel; Hilland, Magnus & Clemm, Hege Synnøve Havstad (2024). Understanding Speech-Language Pathology and Surgical Interventions for Exercise-Induced Laryngeal Obstruction. Immunology and allergy clinics of North America. ISSN 0889-8561. doi: 10.1016/j.iac.2024.09.002. Full text in Research Archive
• Bårdsen, Tonje; Satrell, Emma; Røksund, Ola Drange; Benestad, Merete; Hufthammer, Karl Ove & Clemm, Hege Synnøve Havstad [Show all 10 contributors for this article] (2024). Lung function outcomes in adults born extremely preterm across three decades of advancing perinatal medicine. Acta Paediatrica. ISSN 0803-5253. 114(5). doi: 10.1111/apa.17498. Full text in Research Archive Show summary

  Aim: Advances in perinatal medicine from 1980 to 2000 improved survival in extremely preterm (EP) neonates. Long-term effects of these developments remain unclear, and we aimed to investigate potential cohort effects on adult lung function. Methods: Three 18-year-old population-based cohorts born at ≤28 weeks gestation or with birthweight ≤1000 g during 1982–85, 1991–92 and 1999–2000 and term-controls underwent spirometry, body plethysmography, and tests of lung diffusing capacity, bronchodilator reversibility, and airway hyperresponsiveness. We used Welch's t-tests to compare term- with EP-born as a group and split by bronchopulmonary dysplasia (BPD), and regression models to test group/cohort interactions. Results: In all EP-born cohorts, z-scores for FEV1, FEV1/FVC, FEF25%–75%, DLCO and KCO were reduced compared with term-born. For the 82–85, 91–92 and 99–00 cohorts, deficits for z-FEV1 and z-DLCO were 1.23 and 0.53; 0.68 and 0.92; and 0.51 and 0.57, respectively (p ≤0.01 for all). Cohort analyses showed stable lung function across the three cohorts overall, but improvements across cohorts for the BPD subgroups in z-FEV1, z-FEV1/FVC, and z-FEF25%–75%. Conclusion: Adults born EP across three formative decades of neonatal care had stable lung function overall, with notable improvements in BPD subgroups across cohorts.

• Brekka, Anne Kristine; Ntoumenopoulos, George; Røksund, Ola Drange; Engeset, Merete Salveson; Clemm, Hege Synnøve Havstad & Halvorsen, Thomas [Show all 8 contributors for this article] (2024). Use of Laryngeal Ultrasound to Observe Laryngeal Movements During Noninvasive Ventilation in Healthy Volunteers. Respiratory care. ISSN 0020-1324. 70(3), p. 249–257. doi: 10.4187/respcare.12201. Full text in Research Archive
• Leong, Paul; Vertigan, Anne E.; Hew, Mark; Baxter, Malcolm; Phyland, Debra & Hull, James H. [Show all 14 contributors for this article] (2023). Diagnosis of vocal cord dysfunction/inducible laryngeal obstruction: an International Delphi Consensus Study. Journal of Allergy and Clinical Immunology. ISSN 0091-6749. doi: 10.1016/j.jaci.2023.06.007. Full text in Research Archive
• Muralitharan, Praveen; Carlsen, Petter; Hilland, Magnus; Delestre-Levai, Irisz; Vollsæter, Maria & Hufthammer, Karl Ove [Show all 10 contributors for this article] (2023). Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended. European Respiratory Journal Open Research (ERJ Open Research). 9(1). doi: 10.1183/23120541.00308-2022. Full text in Research Archive Show summary

  Introduction: Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic receptor antagonist used to treat asthma that is suggested in a few reports to improve EILO symptoms. The aim of the present study was to investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE scores. Methods: A randomised crossover trial was conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE score ≥3 (range 0–12). Two consecutive CLE tests were performed within 2 weeks, one test with and one test without prior administration of inhaled IB in a randomised order. Main outcomes were the CLE score, dyspnoea measured using a modified BORG scale (range 0–10) and cardiopulmonary exercise data provided by the CLE test. Results: 20 participants (14 females) aged 12–25 years participated, and all ran to exhaustion on both tests. Mean CLE score, BORG score and peak oxygen consumption were similar in tests performed with and without IB; mean differences (95% confidence interval) were 0.08 (−0.28–0.43), 0.35 (−0.29–0.99) and −0.4 (−1.9–1.1) mL·kg−1·min−1, respectively. Conclusion: Inhaled IB did not improve CLE score, dyspnoea or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.

• Rogde, Åse Johnsen; Lehmann, Sverre; Halvorsen, Thomas; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange & Hufthammer, Karl Ove [Show all 9 contributors for this article] (2023). Prevalence and impact of exercise-induced laryngeal obstruction in asthma: a study protocol for a cross-sectional and longitudinal study. BMJ Open. 13(6). doi: 10.1136/bmjopen-2022-071159. Full text in Research Archive Show summary

  Introduction Exercise-induced laryngeal obstruction (EILO) and exercise-induced asthma can cause troublesome respiratory symptoms that can be difficult to distinguish between. Further, there is now a growing appreciation that the two conditions may coexist, complicating the interpretation of symptoms. The primary aim of this study is to investigate the prevalence of EILO in patients with asthma. Secondary aims include evaluation of EILO treatment effects and investigation of comorbid conditions other than EILO in patients with asthma. Methods and analysis The study will be conducted at Haukeland University Hospital and Voss Hospital in Western Norway, and enrol 80–120 patients with asthma and a control group of 40 patients without asthma. Recruitment started in November 2020, and data sampling will continue until March 2024. Laryngeal function will be assessed at baseline and at a 1-year follow-up, using continuous laryngoscopy during high-intensity exercise (CLE). Immediately after the EILO diagnosis is verified, patients will be treated with standardised breathing advice guided by visual biofeedback from the laryngoscope video screen. The primary outcome will be the prevalence of EILO in patients with asthma and control participants. Secondary outcomes include changes in CLE scores, asthma-related quality of life, asthma control and number of the asthma exacerbations, as assessed between baseline and the 1-year follow-up. Ethics and dissemination Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics, Western Norway, (ID number 97615). All participants will provide signed informed consent before enrolment. The results will be presented in international journals and conferences.

• Fretheim-Kelly, Zoe; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Hilland, Magnus; Vollsæter, Maria & Halvorsen, Thomas (2023). Translaryngeal Resistance: A Measurement to Assist Decision Making in Upper Airway Pathology. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 208(6), p. E32–E34. doi: 10.1164/rccm.202205-0961IM. Full text in Research Archive
• Schwellnus, Martin; Adami, Paolo Emilio; Bougault, Valerie; Budgett, Richard; Clemm, Hege Synnøve Havstad & Derman, Wayne [Show all 21 contributors for this article] (2022). International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness. British Journal of Sports Medicine. ISSN 0306-3674. 56(19), p. 1089–1103. doi: 10.1136/bjsports-2022-105567. Full text in Research Archive
• Schwellnus, Martin; Adami, Paolo Emilio; Bougault, Valerie; Budgett, Richard; Clemm, Hege Synnøve Havstad & Derman, Wayne [Show all 21 contributors for this article] (2022). International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: Acute respiratory infections. British Journal of Sports Medicine. ISSN 0306-3674. 56(19), p. 1066–1088. doi: 10.1136/bjsports-2022-105759. Full text in Research Archive
• Clemm, Hege Synnøve Havstad; Olin, J Tod; McIntosh, Cameron; Schwellnus, Martin; Sewry, Nicola & Hull, James H. [Show all 7 contributors for this article] (2022). Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on 'acute respiratory illness in the athlete'. British Journal of Sports Medicine. ISSN 0306-3674. 56(11), p. 622–629. doi: 10.1136/bjsports-2021-104704. Full text in Research Archive Show summary

  Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper airway dysfunction in young individuals and athletes, can impair exercise performance and mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction. Over the past two decades, there has been considerable progress in the recognition and assessment of EILO in sports medicine. EILO is a highly prevalent cause of unexplained dyspnoea and wheeze in athletes. The preferred diagnostic approach is continuous visualisation of the larynx (via laryngoscopy) during high-intensity exercise. Recent data suggest that EILO consists of different subtypes, possibly caused via different mechanisms. Several therapeutic interventions for EILO are now in widespread use, but to date, no randomised clinical trials have been performed to assess their efficacy or inform robust management strategies. The aim of this review is to provide a state-of-the-art overview of EILO and guidance for clinicians evaluating and treating suspected cases of EILO in athletes. Specifically, this review examines the pathophysiology of EILO, outlines a diagnostic approach and presents current therapeutic algorithms. The key unmet needs and future priorities for research in this area are also covered.

• Vollsæter, Maria; Stensrud, Trine; Maat, Robert; Halvorsen, Thomas; Røksund, Ola Drange & Sandnes, Astrid [Show all 7 contributors for this article] (2022). Exercise related respiratory problems in the young—Is it exercise-induced bronchoconstriction or laryngeal obstruction? Frontiers in Pediatrics. 9. doi: 10.3389/fped.2021.800073. Full text in Research Archive Show summary

  Complaints of breathlessness during heavy exercise is common in children and adolescents, and represent expressions of a subjective feeling that may be difficult to verify and to link with specific diagnoses through objective tests. Exercise-induced asthma and exercise-induced laryngeal obstruction are two common medical causes of breathing difficulities in children and adolescents that can be challenging to distinguish between, based only on the complaints presented by patients. However, by applying a systematic clinical approach that includes rational use of tests, both conditions can usually be diagnosed reliably. In this invited mini-review, we suggest an approach we find feasible in our everyday clinical work.

• Engan, Mette; Engeset, Merete Salveson; Sandvik, Lorentz; Gamlemshaug, Ole Christer Oma; Engesæter, Ingvild Øvstebø & Øymar, Knut Asbjørn Alexander [Show all 11 contributors for this article] (2022). Left vocal cord paralysis, lung function and exercise capacity in young adults born extremely preterm with a history of neonatal patent ductus arteriosus surgery—A national cohort study. Frontiers in Pediatrics. 9. doi: 10.3389/fped.2021.780045. Full text in Research Archive Show summary

  Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses. Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term. Methods: Adults born EP (<28 weeks' gestation or birth weight <1,000 g) in Norway during 1999–2000 who underwent neonatal PDA surgery and controls born EP and at term were invited to complete questionnaires mapping voice-and respiratory symptoms, and to perform spirometry and maximal treadmill exercise testing. In the PDA-surgery group, exercise tests were performed with a laryngoscope positioned to evaluate laryngeal function. Results: Thirty out of 48 (63%) eligible PDA-surgery subjects were examined at mean (standard deviation) age 19.4 (0.8) years, sixteen (53%) had LVCP. LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, not with lung function or peak oxygen consumption (VO2peak). In the PDA-surgery group, forced expiratory volume in 1 second z-score (z-FEV1) was reduced compared to EP-born controls (n = 30) and term-born controls (n = 36); mean (95% confidence interval) z-FEV1 was −1.8 (−2.3, −1.2), −0.7 (−1.1, −0.3) and −0.3 (−0.5, −0.0), respectively. For VO2peak, corresponding figures were 37.5 (34.9, 40.2), 38.1 (35.1, 41.1), and 43.6 (41.0, 46.5) ml/kg/min, respectively. Conclusions: LVCP was common in EP-born young adults who had undergone neonatal PDA surgery. Within the PDA-surgery group, LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, however we did not find an association with lung function or exercise capacity. Overall, the PDA-surgery group had reduced lung function compared to EP-born and term-born controls, whereas exercise capacity was similarly reduced for both the PDA-surgery and EP-born control groups when compared to term-born controls.

• Kvidaland, Haakon Kristian; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Vollsæter, Maria; Hardie, Jon Andrew & Stadheim, Sandra [Show all 7 contributors for this article] (2022). Is it feasible to perform a continuous laryngoscopy exercise test with a cold air inhalate? A case report. European Respiratory Journal Open Research (ERJ Open Research). doi: 10.1183/23120541.00222-2022. Full text in Research Archive
• Gundersen, Hilde; Riiser, Amund; Algrøy, Erling Andre; Vestbøstad, Mona; Sæterbakken, Atle Hole & Clemm, Hege Synnøve Havstad [Show all 10 contributors for this article] (2022). Associations between biological maturity level, match locomotion, and physical capacities in youth male soccer players. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 32(11), p. 1592–1601. doi: 10.1111/sms.14225. Full text in Research Archive Show summary

  Introduction: Biological maturity level has shown to affect sport performance in youths. However, most previous studies have used noninvasive methods to estimate maturity level. Thus, the main aim of the present study was to investigate the association between skeletal age (SA) as a measure of biological maturation level, match locomotion, and physical capacity in male youth soccer players. Method: Thirty-eight Norwegian players were followed during two consecutive seasons (U14 and U15). Match locomotion was assessed with GPS-tracking in matches. SA, assessed by x-ray, physical capacities (speed, strength and endurance) and anthropometrics were measured in the middle of each season. Analysis of associations between SA, match locomotion, and physical capacities were adjusted for the potential confounding effect of body height and weight. Results: In matches, positive associations were found between SA and maximal speed and running distance in the highest speed zones. Further, SA was associated with 40 m sprint time and countermovement jump (CMJ) height, and with intermittent-endurance capacity after adjusting for body height (U14). Associations between SA and leg strength and power, and between SA and absolute VO2max were not significant after adjusting for body weight. There was no association between SA and total distance covered in matches. Conclusion: Biological maturity level influence match locomotion and performance on physical capacity tests. It is important that players, parents and coaches are aware of the advantages more mature players have during puberty, and that less mature players also are given attention, appropriate training and match competition to ensure proper development.

• Andersen, Tiina Maarit; Fondenes, Ove; Røksund, Ola Drange; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas & Vollsæter, Maria (2022). From bedside to bench - In vivo and in vitro evaluation of mechanically assisted cough treatment in a patient with bulbar Amyotrophic Lateral Sclerosis. Respiratory Medicine Case Reports. 37, p. 1–4. doi: 10.1016/j.rmcr.2022.101649. Full text in Research Archive
• Brekka, Anne Kristine; Vollsæter, Maria; Ntoumenopoulos, George; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas & Røksund, Ola Drange [Show all 7 contributors for this article] (2022). Adjustments of non-invasive ventilation and mechanically assisted cough by combining ultrasound imaging of the larynx with transnasal fibre-optic laryngoscopy: A protocol for an experimental study. BMJ Open. 12(5), p. 1–7. doi: 10.1136/bmjopen-2021-059234. Full text in Research Archive
• Jansrud, Ida; Halvorsen, Thomas; Vollsæter, Maria; Hilland, Magnus; Heimdal, John-Helge & Røksund, Ola Drange [Show all 7 contributors for this article] (2022). Conundrums in the breathless athlete; exercise-induced laryngeal obstruction or asthma? Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 32(6), p. 1041–1049. doi: 10.1111/sms.14137. Full text in Research Archive Show summary

  Purpose: Exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) are the two disorders commonly considered when athletes complain of exertional dyspnea. They are highly different but often confused. We aimed to address this diagnostic challenge and its consequences in elite athletes. Methods: We included all athletes competing at national or international level, referred to our institution for workup for EILO during 2013–2016. We diagnosed EILO from video-recorded laryngoscopy performed during maximal cardiopulmonary treadmill exercise (CLE test). Symptoms and previous diagnostic evaluations were obtained from referral letters and chart reviews. Results: Exercise-induced laryngeal obstruction was diagnosed in 73/101 referred athletes, of whom 70/73 had moderate/severe supraglottic obstruction and 3/73 had primarily glottic obstruction with only minor supraglottic involvement. Of the 73 athletes with EILO, we were able to identify objective tests for asthma in 55 participants, of whom 22 had findings supporting asthma. However, 58/73 had used asthma therapy at some time previously, with current use in 28. Only three reported that asthma medication had improved their exercise-related breathing problems, two of whom with tests confirming asthma. Treatment for EILO improved breathing problems in all but four. Conclusions: Objective testing verified EILO in most of the referred athletes. EILO coexisting with asthma was common, and large proportions had used asthma medication; however, few reported effect on exercise-related breathing problems. Unexplained persistent exertional dyspnea must not lead to indiscriminate escalation of asthma treatment, but instead incite investigation for EILO, either as a co-morbidity or as a differential diagnosis.

• Fretheim-Kelly, Zoe; Engan, Mette; Clemm, Hege Synnøve Havstad; Andersen, Tiina Maarit; Heimdal, John-Helge & Strand, Eric [Show all 9 contributors for this article] (2022). Reliability of translaryngeal airway resistance measurements during maximal exercise. European Respiratory Journal Open Research (ERJ Open Research). 8(1), p. 1–9. doi: 10.1183/23120541.00581-2021. Full text in Research Archive Show summary

  Objective Exercise-induced laryngeal obstruction is an important cause of exertional dyspnoea. The diagnosis rests on visual judgement of relative changes of the laryngeal inlet during continuous laryngoscopy exercise (CLE) tests, but we lack objective measures that reflect functional consequences. We aimed to investigate repeatability and normal values of translaryngeal airway resistance measured at maximal intensity exercise. Methods 31 healthy nonsmokers without exercise-related breathing problems were recruited. Participants performed two CLE tests with verified positioning of two pressure sensors, one at the tip of the epiglottis (supraglottic) and one by the fifth tracheal ring (subglottic). Airway pressure and flow data were continuously collected breath-by-breath and used to calculate translaryngeal resistance at peak exercise. Laryngeal obstruction was assessed according to a standardised CLE score system. Results Data from 26 participants (16 females) with two successful tests and equal CLE scores on both test sessions were included in the translaryngeal resistance repeatability analyses. The coefficient of repeatability (CR) was 0.62 cmH2O·L−1·s−1, corresponding to a CR% of 21%. Mean±sd translaryngeal airway resistance (cmH2O·L−1·s−1) in participants with no laryngeal obstruction (n=15) was 2.88±0.50 in females and 2.18±0.50 in males. Higher CLE scores correlated with higher translaryngeal resistance in females (r=0.81, p<0.001). Conclusions This study establishes translaryngeal airway resistance obtained during exercise as a reliable parameter in respiratory medicine, opening the door for more informed treatment decisions and future research on the role of the larynx in health and disease.

• Bårdsen, Tonje; Røksund, Ola Drange; Benestad, Merete; Hufthammer, Karl Ove; Clemm, Hege Synnøve Havstad & Mikalsen, Ingvild Bruun [Show all 10 contributors for this article] (2022). Tracking of lung function from 10 to 35 years after being born extremely preterm or with extremely low birth weight. Thorax. ISSN 0040-6376. 77(8), p. 790–798. doi: 10.1136/thoraxjnl-2021-218400. Full text in Research Archive Show summary

  Background: Lifelong pulmonary consequences of being born extremely preterm or with extremely low birth weight remain unknown. We aimed to describe lung function trajectories from 10 to 35 years of age for individuals born extremely preterm, and address potential cohort effects over a period that encompassed major changes in perinatal care. Methods: We performed repeated spirometry in three population-based cohorts born at gestational age ≤28 weeks or with birth weight ≤1000 g during 1982–85, 1991–92 and 1999–2000, referred to as extremely preterm-born, and in term-born controls matched for age and gender. Examinations were performed at 10, 18, 25 and 35 years. Longitudinal data were analysed using mixed models regression, with the extremely preterm-born stratified by bronchopulmonary dysplasia (BPD). Results: We recruited 148/174 (85%) eligible extremely preterm-born and 138 term-born. Compared with term-born, the extremely preterm-born had lower z-scores for forced expiratory volume in 1 s (FEV1) at most assessments, the main exceptions were in the groups without BPD in the two youngest cohorts. FEV1 trajectories were largely parallel for the extremely preterm- and term-born, also during the period 25–35 years that includes the onset of the age-related decline in lung function. Extremely preterm-born had lower peak lung function than term-born, but z-FEV1 values improved for each consecutive decade of birth (p=0.009). More extremely preterm—than term-born fulfilled the spirometry criteria for chronic obstructive pulmonary disease, 44/148 (30%) vs 7/138 (5%), p<0.001. Conclusions: Lung function after extremely preterm birth tracked in parallel, but significantly below the trajectories of term-born from 10 to 35 years, including the incipient age-related decline from 25 to 35 years. The deficits versus term-born decreased with each decade of birth from 1980 to 2000.

• Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Andersen, Tiina Maarit; Heimdal, John-Helge; Karlsen, Tom & Hilland, Magnus [Show all 12 contributors for this article] (2022). Exercise-induced Laryngeal Obstruction: Protocol for a Randomized Controlled Treatment Trial. Frontiers in Pediatrics. 10. doi: 10.3389/fped.2022.817003. Full text in Research Archive Show summary

  Background: Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young individuals, caused by paradoxical inspiratory adduction of laryngeal structures, and diagnosed by continuous visualization of the larynx during high-intensity exercise. Empirical data suggest that EILO consists of different subtypes, possibly requiring different therapeutic approaches. Currently applied treatments do not rest on randomized controlled trials, and international guidelines based on good evidence can therefore not be established. This study aims to provide evidence-based information on treatment schemes commonly applied in patients with EILO. Methods and Analysis: Consenting patients consecutively diagnosed with EILO at Haukeland University Hospital will be randomized into four non-invasive treatment arms, based on promising reports from non-randomized studies: (A) standardized information and breathing advice only (IBA), (B) IBA plus inspiratory muscle training, (C) IBA plus speech therapy, and (D) IBA plus inspiratory muscle training and speech therapy. Differential effects in predefined EILO subtypes will be addressed. Patients failing the non-invasive approach and otherwise qualifying for surgical treatment by current department policy will be considered for randomization into (E) standard or (F) minimally invasive laser supraglottoplasty or (G) no surgery. Power calculations are based on the main outcomes, laryngeal adduction during peak exercise, rated by a validated scoring system before and after the interventions. Ethics and Dissemination: The study will assess approaches to EILO treatments that despite widespread use, are insufficiently tested in structured, verifiable, randomized, controlled studies, and is therefore considered ethically sound. The study will provide knowledge listed as a priority in a recent statement issued by the European Respiratory Society, requested by clinicians and researchers engaged in this area, and relevant to 5–7% of young people. Dissemination will occur in peer-reviewed journals, at relevant media platforms and conferences, and by engaging with patient organizations and the healthcare bureaucracy.

• Lie, Astrid Haugen; Grønnevik, Ingvild; Frisk, Bente; Røksund, Ola Drange; Jansrud, Ida & Vollsæter, Maria [Show all 8 contributors for this article] (2021). Breathing patterns in people with exercise-induced laryngeal obstruction. Physiological Reports. 9(22), p. 1–10. doi: 10.14814/phy2.15086. Full text in Research Archive Show summary

  Exercise-induced laryngeal obstruction (EILO) is common, but we lack readily available diagnostic tools. The larynx represents an important point of resistance in the airways, and we therefore hypothesized that EILO is associated with characteristic breathing patterns possible to record from a standard incremental ergospirometry test. We studied 24 individuals with moderate/severe EILO and 20 individuals with no-EILO, mean (SD) age 17 (6.1) and 24 (6.4) years, respectively. EILO versus no-EILO was verified from maximal continuouslaryngoscopy treadmill exercise (CLE) tests, which also included ergospirometry. We described the relationships between minute ventilation (V̇ E) versus tidal volume (VT) and V̇ E versus carbon dioxide output (V̇ CO2), using respectively quadratic and linear equations, and applied adjusted regression models to compare ergospirometry data and curve parameters. Compared to the no-EILO group, the group with EILO had prolonged inspiratory time (Tin), lower breathing frequency (Bf ), lower V̇ E, and lowerinspiratory flow rate (V̇ in) at peak exercise. Mathematical modeling of the breathing pattern relationships was feasible in both groups, with similar coefficients of variation. For V̇ E versus VT, the mathematical curve parameters were similar. For V̇ E versus V̇ CO2, the slope was similar but the intercept was lower in the EILO group. EILO was associated with prolonged Tin, lower Bf , V̇ E, andV̇ E. The relationship betweenV̇ E versus VT wassimilar, whereasforV̇ E versus V̇ CO2, the slope was almost parallel but shifted downward for the EILO group. Most ergospirometry data overlapped, except V̇ in which discriminated between EILO and no-EILO in a promising way.

• Sandnes, Astrid; Andersen, Tiina Maarit; Clemm, Hege Synnøve Havstad; Hilland, Magnus; Heimdal, John-Helge & Halvorsen, Thomas [Show all 8 contributors for this article] (2021). Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. European Archives of Oto-Rhino-Laryngology. ISSN 0937-4477. doi: 10.1007/s00405-021-07214-5. Full text in Research Archive Show summary

  Purpose: Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4-6 years later. Methods: Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2-4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4-6 years, both groups were re-assessed with a questionnaire. Results: We identified 116 eligible patients from the EILO-register. Response rates after 4-6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2-4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7-0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4-6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion: Self-reported EILO symptoms had improved after 4-6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered. Keywords: Dyspnea; Exercise; Inspiratory muscle training; Laryngeal obstruction; Stridor. © 2021. The Author(s).

• Engan, Mette; Jansrud, Ida; Bekken, Marianne; Halvorsen, Thomas; Fretheim-Kelly, Zoe Louise & Vollsæter, Maria [Show all 9 contributors for this article] (2021). Reliability of maximum oxygen uptake in cardiopulmonary exercise testing with continuous laryngoscopy. European Respiratory Journal Open Research (ERJ Open Research). 7(1), p. 1–9. doi: 10.1183/23120541.00825-2020. Full text in Research Archive Show summary

  Aims: A cardiopulmonary exercise test (CPET) is the gold standard to evaluate symptom-limiting exercise intolerance, while continuous laryngoscopy performed during exercise (CLE) is required to diagnose exercise-induced laryngeal obstruction. Combining CPET with CLE would save time and resources; however, the CPET data may be distorted by the extra equipment. We therefore aimed to study whether CPET with CLE influences peak oxygen uptake (V′O2peak) and other gas exchange parameters when compared to a regular CPET. Methods: Forty healthy athletes without exercise-related breathing problems, 15–35 years of age, performed CPET to peak exercise with and without an added CLE set-up, in randomised order 2–4 days apart, applying an identical computerised treadmill protocol. Results: At peak exercise, the mean difference (95% confidence interval) between CPET with and without extra CLE set-up for V′O2peak, respiratory exchange ratio (RER), minute ventilation (V′E) and heart rate (HR) was 0.2 (−0.4 to 0.8) mL·kg−1·min−1, 0.01(−0.007 to 0.027) units, 2.6 (−1.3 to 6.5) L·min−1 and 1.4 (−0.8 to 3.5) beats·min−1, respectively. Agreement (95% limits of agreement) for V′O2peak, RER and V′E was 0.2 (±3.7) mL·kg−1·min−1, 0.01 (±0.10) units and 2.6 (±24.0) L·min−1, respectively. No systematic or proportional bias was found except for the completed distance, which was 49 m (95% CI 16 to 82 m) longer during CPET. Conclusion: Parameters of gas exchange, including V′O2peak and RER, obtained from a maximal CPET performed with the extra CLE set-up can be used interchangeably with data obtained from standard CPET, thus preventing unnecessary additional testing.

• Satrell, Emma Elsa Carolina; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Hufthammer, Karl Ove; Thorsen, Einar & Halvorsen, Thomas [Show all 7 contributors for this article] (2021). Development of lung diffusion to adulthood following extremely preterm birth. European Respiratory Journal. ISSN 0903-1936. 59(5). doi: 10.1183/13993003.04103-2020. Full text in Research Archive Show summary

  Background: Gas exchange in extremely preterm (EP) infants must take place in fetal lungs. Childhood lung diffusing capacity of the lung for carbon monoxide (DLCO) is reduced; however, longitudinal development has not been investigated. We describe the growth of DLCO and its subcomponents to adulthood in EP compared with term-born subjects. Methods: Two area-based cohorts born at gestational age ≤28 weeks or birthweight ≤1000 g in 1982–1985 (n=48) and 1991–1992 (n=35) were examined twice, at ages 18 and 25 years and 10 and 18 years, respectively, and compared with matched term-born controls. Single-breath DLCO was measured at two oxygen pressures, with subcomponents (membrane diffusion (DM) and pulmonary capillary blood volume (VC)) calculated using the Roughton–Forster equation. Results: Age-, sex- and height-standardised transfer coefficients for carbon monoxide (KCO) and DLCO were reduced in EP compared with term-born subjects, and remained so during puberty and early adulthood (p-values for all time-points and both cohorts ≤0.04), whereas alveolar volume (VA) was similar. Development occurred in parallel to term-born controls, with no signs of pubertal catch-up growth nor decline at age 25 years (p-values for lack of parallelism within cohorts 0.99, 0.65, 0.71, 0.94 and 0.44 for z-DLCO, z-VA, z-KCO, DM and VC, respectively). Split by membrane and blood volume components, findings were less clear; however, membrane diffusion seemed most affected. Conclusions: Pulmonary diffusing capacity was reduced in EP compared with term-born subjects, and development from childhood to adulthood tracked in parallel to term-born subjects, with no signs of catch-up growth nor decline at age 25 years.

• Rogde, Åse Johnsen; Lehmann, Sverre; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Kvidaland, Haakon Kristian & Halvorsen, Thomas [Show all 8 contributors for this article] (2021). Inducible laryngeal obstruction in asthma. European Respiratory Journal. ISSN 0903-1936. doi: 10.1183/13993003.congress-2021.PA1109. Full text in Research Archive
• Stadheim, Sandra; Bø, Signe; Røksund, Ola Drange; Kvidaland, Haakon Kristian; Clemm, Hege Synnøve Havstad & Hardie, Jon Andrew (2021). CLE-test with cold air as provocation factor – a feasibility study. European Respiratory Journal. ISSN 0903-1936. doi: 10.1183/13993003.congress-2021.PA3223. Full text in Research Archive
• Benestad, Merete Røineland; Drageset, Jorunn; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Vollsæter, Maria & Halvorsen, Thomas [Show all 8 contributors for this article] (2021). Self-Reported Health in Adolescents With Exercise-Induced Laryngeal Obstruction; A Cross-Sectional Study. Frontiers in Pediatrics. 9, p. 1–7. doi: 10.3389/fped.2021.617759. Full text in Research Archive Show summary

  Background: Exercise-induced laryngeal obstruction (EILO) is common in young people with exertional breathing difficulties. Psychological characteristics have been proposed as underlying contributors; however, the evidence for this is limited. Objectives: Describe self-reported health, self-efficacy, and anxiety symptoms in adolescents with EILO, and address possible associations with EILO subtypes and severity. Methods: Cross-sectional study of 71/180 (39%) adolescents tested for EILO at Haukeland University Hospital during 2014–2016, age range 14–18 years. Validated questionnaires were used to assess general self-rated health, subjective health complaints (Health Behavior in School-aged Children-Symptom Check List; HBSC-SCL), general self-efficacy (GSE), and anxiety symptoms (SCARED). The outcomes were compared with normative data from comparable unselected populations. Results: The HBSC-SCL items for somatic complaints revealed weekly or more often occurrence of headache in 42%, abdominal pain in 30%, backache in 31%, and dizziness in 32%. For psychological complaints, corresponding figures were 26% for feeling low, 43% for irritability or bad mood, 33% for feeling nervous, and 38% for sleep problems. Mean (range) GSE score was 3.13 (2.2–4.0), and reports suggesting anxiety symptoms were rare. The outcomes were in line with normative data from comparable unselected populations. Self-rated health, and scores obtained for HBSC-SCL, GSE, and SCARED were similarly distributed across EILO subtypes and severity. Conclusion: Self-reported health, self-efficacy, and level of anxiety symptoms in adolescents with laryngoscopically confirmed EILO were similar to data obtained in comparable unselected populations, irrespective of EILO subtype and severity. The findings challenge the notion that pediatric EILO is causally related to psychological problems.

• McIntosh, Cameron; Clemm, Hege Synnøve Havstad; Sewry, Nicola; Hrubos-Strøm, Harald & Schwellnus, Martin P. (2021). Diagnosis and management of nasal obstruction in the athlete. A narrative review by subgroup B of the IOC Consensus Group on "Acute Respiratory Illness in the Athlete". Journal of Sports Medicine and Physical Fitness. ISSN 0022-4707. 61(8), p. 1144–1158. doi: 10.23736/S0022-4707.21.12821-X. Full text in Research Archive Show summary

  Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.

• Engan, Mette; Jansrud, Ida; Stensrud, Trine; Gundersen, Hilde; Edvardsen, Elisabeth & Clemm, Hege Havstad (2020). Pust opp Stolzen. Norsk idrettsmedisin. ISSN 0806-9328. Full text in Research Archive
• Engeseth, Merete Salveson; Engan, Mette; Clemm, Hege Synnøve Havstad; Vollsæter, Maria; Nilsen, Roy Miodini & Markestad, Trond Jacob [Show all 8 contributors for this article] (2020). Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus. Frontiers in Pediatrics. 8. doi: 10.3389/fped.2020.00150. Full text in Research Archive Show summary

  Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA). Study design: Prospective follow-up of all children born in Norway during 1999–2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires. Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes. Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.

• Sautter, Marie; Halvorsen, Thomas; Engan, Mette; Clemm, Hege Havstad & Bentsen, Mariann (2020). Electromagnetic inductance plethysmography to study airflow after nebulized saline in bronchiolitis. Pediatric Pulmonology. ISSN 8755-6863. doi: 10.1002/ppul.25058. Full text in Research Archive
• Engan, Mette; Engeseth, Merete Salveson; Fevang, Silje Katrine Elgen; Vollsæter, Maria; Eide, Geir Egil & Røksund, Ola Drange [Show all 8 contributors for this article] (2020). Predicting physical activity in a national cohort of children born extremely preterm. Early Human Development. ISSN 0378-3782. 145:105037, p. 1–8. doi: 10.1016/j.earlhumdev.2020.105037. Full text in Research Archive Show summary

  Predicting physical activity in a national cohort of children born extremely preterm. Objectives: To compare physical activity among school-aged children born extremely preterm or with extremely low birthweight (EP/ELBW) to term-born children, and to identify early predictors for physical inactivity in the EP/ELBW-children. Methods: A national cohort born during 1999–2000 at gestational age < 28 weeks or birthweight <1000 g and term-born controls were assessed. EP/ELBW-children without neurodevelopmental disabilities were labeled “healthy”. At five years, we examined the EP/ELBW-children's motor, mental and intellectual functioning using the Movement Assessment Battery for Children (MABC), The Strength and Difficulties Questionnaire (SDQ) and The Wechsler Preschool and Primary Scale of Intelligence-revised. At 11 years, the parents reported their children's physical activity (PA) in questionnaires. Results: Information was obtained from 231/372 EP/ELBW and 57/61 term-born children. At 11 years, EP/ELBW-children had fewer exercise events per week, were less engaged in team sports, had lower endurance, lower sports proficiency, and were less vigorous during PA than term-born children (p < 0.05). Low sports proficiency in the healthy EP/ELBW-children at 11 years was predicted (odds ratio; 95% confidence interval) by abnormal MABC-score (3.0; 1.0 to 8.7), and abnormal SDQ-score (4.0; 1.6 to 10.0) at 5 years. Lower endurance at PA was predicted by abnormal MABC-score (2.6; 1.0 to 6.6), abnormal SDQ-score (3.0; 1.4 to 6.5), and borderline intellectual functioning (4.2; 1.8 to 10.1). Conclusions: Eleven-year-old EP/ELBW-children were less physically active than term-born. In healthy EP/ELBW-children, impaired motor coordination, borderline intellectual functioning and behavioral problems at 5 years of age predicted unfavorable PA habits at 11 years.

• Engan, Mette; Jansrud, Ida; Stensrud, Trine; Gundersen, Hilde; Edvardsen, Elisabeth & Clemm, Hege Havstad (2020). Changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running. BMJ Open sport & exercise medicine. 6(1), p. 1–6. doi: 10.1136/bmjsem-2020-000815. Full text in Research Archive Show summary

  Objective: To evaluate changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running. Methods: Healthy volunteers participated in an uphill race. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and 5 and 10 min after finishing the race. Capillary blood lactate concentration ([BLa-]) and Borg score for perceived exertion were registered immediately after the race. One participant wore a portable video-laryngoscope during the race, and the video was assessed for technical performance. Results: Twenty adult subjects participated with a mean (SD) age of 40.2 (9.7) years. Mean (SD) race duration and post-exercise [BLa-] was 13.9 (2.3) min and 10.7 (2.1) mmol/L, respectively, and the median (range) Borg score for perceived exertion was 9 (5–10). Mean percentage change (95% CI) 5 and 10 min post-exercise in FEV1 were 6.9 (3.7 to 10.2) % and 5.9 (2.7 to 9.0) %, respectively, and in FVC 5.2 (2.3 to 8.1) % and 4.7 (1.6 to 7.9) %, respectively. The recorded video of the larynx was of good quality. Conclusions: Maximal aerobic field exercise induced bronchodilatation in the majority of the healthy non-asthmatic participants. It is feasible to perform continuous video-laryngoscopy during heavy uphill exercise.

• Fretheim-Kelly, Zoe; Halvorsen, Thomas; Heimdal, John-Helge; Strand, Eric; Vollsæter, Maria & Clemm, Hege Synnøve Havstad [Show all 7 contributors for this article] (2019). Feasibility and tolerability of measuring translaryngeal pressure during exercise. The Laryngoscope. ISSN 0023-852X. 129, p. 2748–2753. doi: 10.1002/lary.27846. Full text in Research Archive Show summary

  Objectives/Hypothesis: To determine if simultaneous tracheal and supraglottic pressure measurement performed during a continuous laryngoscopy exercise (CLE) test is possible, tolerable, and feasible, and if so, whether measurements can be used to determined airflow resistance over the larynx, thus providing an objective outcome measure for the CLE test, the gold standard for diagnosing exercise‐induced laryngeal obstruction. Study Design: Explorative descriptive clinical study. Methods: A CLE test was performed with the addition of two pressure sensors (Mikro‐Cath 825‐0101; Millar, Houston, TX) placed at the epiglottic tip and at the fifth tracheal ring. To place sensors, laryngeal anesthesia and a channel scope were required. Tolerability and feasibility was determined by a Likert score and subjective indication from subjects and operators. Adjustments to the technique were made to increase tolerability. The pressure data were continuously collected and analyzed for artifacts, drifts, frequency response, and used with flow data to calculate translaryngeal resistance. Results: All subjects (n = 7) completed all procedures. Two main areas of concern were identified regarding tolerability: application of topical anesthesia to the larynx and nasal discomfort due to the added diameter of the laryngoscope. Protocol adjustments improved both. Pressure data were obtained from all procedures in all subjects, were consistent, and followed physiological trends. Conclusions: Continuous measurement of the translaryngeal pressure gradient during a CLE test is possible, feasible, and tolerable. A CLE test with direct measurement of the translaryngeal pressure gradient might become a valuable tool in the objective assessment of respiratory function, and normal values should be established in health and disease.

• Sandnes, Astrid; Andersen, Tiina Maarit; Clemm, Hege Synnøve Havstad; Hilland, Magnus; Vollsæter, Maria & Heimdal, John-Helge [Show all 9 contributors for this article] (2019). Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training. BMJ Open sport & exercise medicine. 5(1), p. 1–8. doi: 10.1136/bmjsem-2018-000436. Full text in Research Archive Show summary

  Background Exercise-induced laryngeal obstruction (EILO) is common in athletes and presents with dyspnoea, chest tightness, inspiratory stridor and sometimes panic reactions. The evidence for conservative treatment is weak, but case reports suggest effects from inspiratory muscle training (IMT). We aimed to explore effects from IMT used in athletes with EILO. Method Twenty-eight athletes, mean age 16.4 years, diagnosed with EILO at our clinic, participated in a 6-week treatment programme, using a resistive flow-dependent IMT device (Respifit S). Four athletes competed at international level, 13 at national and 11 at regional levels. Video-recorded continuous transnasal flexible laryngoscopy was performed from rest to peak exercise (continuous laryngoscopy exercise (CLE) test) and scored before and 2–4 weeks after the training period. Ergospirometric variables were obtained from this CLE set-up. Lung function was measured according to guidelines. Symptom scores and demographic variables were obtained from a questionnaire. Results After the treatment period, symptoms had decreased in 22/28 (79%) participants. Mean overall CLE score had improved after treatment (p<0.001), with the scores becoming normal in five athletes but worse in two. Most of the improvement was explained by changes at the glottic laryngeal level (p=0.009). Ergospirometric variables revealed significantly higher peak minute ventilation explained by higher tidal volumes and were otherwise unchanged. Conclusion This explorative study underlines the heterogeneous treatment response of EILO and suggests that IMT may become an efficient conservative treatment tool in subgroups, possibly contributing to better control of the vocal folds. The signals from this study should be tested in future controlled interventional studies.

• Sandnes, Astrid; Hilland, Magnus; Vollsæter, Maria; Andersen, Tiina Maarit; Engesæter, Ingvild Øvstebø & Sandvik, Lorentz [Show all 11 contributors for this article] (2019). Severe exercise-induced laryngeal obstruction treated with supraglottoplasty. Frontiers in Surgery. 6(44), p. 1–9. doi: 10.3389/fsurg.2019.00044. Full text in Research Archive Show summary

  Introduction: Exercise induced laryngeal obstruction (EILO) is relatively common in adolescents, with symptoms often confused with exercise induced asthma. EILO often starts with medial or inward rotation of supraglottic structures of the larynx, whereas glottic adduction appears as a secondary phenomenon in a majority. Therefore, surgical treatment (supraglottoplasty) is used in thoroughly selected and highly motivated patients with pronounced symptoms and severe supraglottic collapse. Aim: To investigate efficacy and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews. Methods: The EILO register at Haukeland University Hospital, Bergen, Norway was used to identify patients who had undergone laser supraglottoplasty for severe supraglottic EILO, verified by continuous laryngoscopy exercise (CLE) test, during 2013–2015. Laser incision in both aryepiglottic folds anterior to the cuneiform tubercles and removal of the mucosa around the top was performed in general anesthesia. Outcomes were questionnaire based self-reported symptoms, and laryngeal obstruction scored according to a defined scheme during a CLE-test performed before and after surgery. Results: Forty-five of 65 eligible patients, mean age 15.9 years, were included. Post-operatively, 38/45 (84%) patients reported less symptoms, whereas CLE-test scores had improved in all, of whom 16/45 (36%) had no signs of obstruction. Most improvements were at the supraglottic level, but 21/45 (47%) also improved at the glottic level. Two of 65 patients had complications; self-limiting vocal fold paresis and scarring/shortening of plica ary-epiglottica. Conclusion: Supraglottoplasty improves symptoms and decreases laryngeal obstruction in patients with severe supraglottic EILO, and appears safe in highly selected cases.

• Engan, Mette; Vollsæter, Maria; Øymar, Knut; Markestad, Trond; Eide, Geir Egil & Halvorsen, Thomas [Show all 8 contributors for this article] (2019). Comparison of physical activity and body composition in a cohort of children born extremely preterm or with extremely low birth weight to matched term-born controls: a follow-up study. BMJ Paediatrics Open. 3:e000481, p. 1–11. doi: 10.1136/bmjpo-2019-000481. Full text in Research Archive Show summary

  Objectives: To compare physical activity and body composition in a cohort of children born extremely preterm/extremely low birth weight (EP/ELBW) with term-born (TB) controls. Methods: A regional cohort of children born during 1999–2000 at gestational age <28 weeks or with birth weight <1000 g and their individually matched TB controls were examined in 2010–2011. Information on physical activity was obtained from parental questionnaires, and body composition was determined by anthropometry and dual X-ray absorptiometry. Results: Fifty-seven EP/ELBW and 57 TB controls were included at a mean age of 11.6 years. Compared with the TB children, the EP/ELBW-born children exercised less often (22% vs 44% exercised more than 3 days per week), had lower physical endurance and poorer proficiency in sports and play and were less vigorous during exercise (p<0.05). They also had lower values (mean; 95 % CI) for muscle mass (0.9; 0.3–1.5 kg), total bone mineral density z-score (0.30; 0.13–0.52 units) and fat mass ratio (0.14; 0.06–0.21 units). The association between physical activity and bone mineral and skeletal muscle mass accrual was significantly weaker for the EP/ELBW-born than the TB children. Conclusions: The EP/ELBW-born children were less physically active, had signs of an unfavourable body composition with less muscle mass and lower bone mineral density than the TB controls. The association between physical activity and the measures of body composition was weaker in the group of EP/ELBW-born children.

• Fretheim-Kelly, Zoe Louise; Halvorsen, Thomas; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Heimdal, John-Helge & Vollsæter, Maria [Show all 8 contributors for this article] (2019). Exercise induced laryngeal obstructions in humans and equines. A comparative review. Frontiers in Physiology. 10:1333, p. 1–10. doi: 10.3389/fphys.2019.01333. Full text in Research Archive Show summary

  Dynamic obstructions of the larynx are a set of disorders that occur during exercise in equines and humans. There are a number of similarities in presentation, diagnosis, pathophysiology and treatment. Both equines and humans present with exercise intolerance secondary to dyspnea. During laryngoscopy at rest, the larynx appears to function normally. Abnormalities are only revealed during laryngoscopy at exercise, seemingly triggered by increased ventilatory demands, and quickly resolve after cessation of exercise. Lower airway disease (asthma being the most prevalent condition), cardiac disease and lack of fitness are the major differentials in both species. Laryngoscopic examination during exercise should be performed from rest to peak exertion to allow for a comprehensive diagnosis, including where the airway collapse begins, and thereafter how it progresses. Dynamic disorders with most visual similarity between humans and equines are: aryepiglottic fold collapse (both species); equine dynamic laryngeal collapse (DLC) relative to some forms of human combined supraglottic/glottic collapse; and epiglottic retroversion (both species). Quantitative grading techniques, such as airway pressure measurement, that have proven effective in veterinary research are currently being piloted in human studies. Conditions that appear visually similar are treated in comparable ways. The similarities of anatomy and certain types of dynamic collapse would suggest that the equine larynx provides a good model for human upper respiratory tract obstruction during exercise. Thus, close collaboration between veterinarians and medical personal may lead to further advancements in understanding pathophysiologic processes, and enhance the development of improved diagnostic tests and treatments that will benefit both species.

• Doyle, Lex W.; Andersson, Sture; Bush, Andy; Cheong, Jeanie L.Y.; Clemm, Hege Synnøve Havstad & Evensen, Kari Anne Indredavik [Show all 18 contributors for this article] (2019). Expiratory airflow in late adolescence and early adulthood in individuals born very preterm or with very low birthweight compared with controls born at term or with normal birthweight: a meta-analysis of individual participant data. The Lancet Respiratory Medicine. ISSN 2213-2600. 7(8), p. 677–686. doi: 10.1016/S2213-2600(18)30530-7. Full text in Research Archive Show summary

  Maximal expiratory airflow peaks early in the third decade of life, then gradually declines with age. The pattern of airflow through adulthood for individuals born very preterm (at <32 weeks’ gestation) or with very low birthweight (<1501 g) is unknown. We aimed to compare maximal expiratory airflow in these individuals during late adolescence and early adulthood with that of control individuals born with normal birthweight (>2499 g) or at term.

• Kotecha, Sailesh; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas & Kotecha, Sarah J. (2018). Bronchial hyper-responsiveness in preterm-born subjects: A systematic review and meta-analysis. Pediatric Allergy and Immunology. ISSN 0905-6157. 29(7), p. 715–725. doi: 10.1111/pai.12957. Full text in Research Archive
• Clemm, Hege Synnøve Havstad & Røksund, Ola Drange (2018). Pusteproblemer under anstrengelse. Paidos: Tidsskrift for Norsk barnelegeforening. ISSN 1503-5360. 38(3), p. 108–109. Full text in Research Archive
• Clemm, Hege Synnøve Havstad; Sandnes, Astrid; Vollsæter, Maria; Hilland, Magnus; Heimdal, John-Helge & Røksund, Ola Drange [Show all 7 contributors for this article] (2018). The Heterogeneity of Exercise-induced Laryngeal Obstruction. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 197(8), p. 1068–1069. doi: 10.1164/rccm.201708-1646IM. Full text in Research Archive
• Clemm, Hege Synnøve Havstad; Engeseth, Merete Salveson; Vollsæter, Maria; Kotecha, Sailesh & Halvorsen, Thomas (2018). Bronchial hyper-responsiveness after preterm birth. Paediatric Respiratory Reviews. ISSN 1526-0542. 26, p. 34–40. doi: 10.1016/j.prrv.2017.06.010. Full text in Research Archive Show summary

  Being born preterm often adversely affects later lung function. Airway obstruction and bronchial hyperresponsiveness (BHR) are common findings. Respiratory symptoms in asthma and in lung disease after preterm birth might appear similar, but clinical experience and studies indicate that symptoms secondary to preterm birth reflect a separate disease entity. BHR is a defining feature of asthma, but can also be found in other lung disorders and in subjects without respiratory symptoms. We review different methods to assess BHR, and findings reported from studies that have investigated BHR after preterm birth. The area appeared understudied with relatively few and heterogeneous articles identified, and lack of a pervasive understanding. BHR seemed related to low gestational age at delivery and a neonatal history of bronchopulmonary dysplasia. No studies reported associations between BHR after preterm birth and the markers of eosinophilic inflammatory airway responses typically found in asthma. This should be borne in mind when treating preterm born individuals with BHR and airway symptoms.

• Andersen, Tiina Maarit; Sandnes, Astrid; Fondenes, Ove; Nilsen, Roy Miodini; Tysnes, Ole-Bjørn & Heimdal, John-Helge [Show all 10 contributors for this article] (2018). Laryngeal responses to mechanically assisted cough in progressing amyotrophic lateral sclerosis. Respiratory care. ISSN 0020-1324. 63(5), p. 538–549. doi: 10.4187/respcare.05924. Full text in Research Archive
• Hestnes, Julie; Hoel, Hedda Benedicte; Risa, Ole Johan; Romstøl, Hanna Omholt; Røksund, Ola Drange & Frisk, Bente [Show all 9 contributors for this article] (2017). Ventilatory efficiency in children and adolescents born extremely preterm. Frontiers in Physiology. 8. doi: 10.3389/fphys.2017.00499. Full text in Research Archive Show summary

  Purpose: Children and adolescents born extremely preterm (EP) have lower dynamic lung volumes and gas transfer capacity than subjects born at term. Most studies also report lower aerobic capacity. We hypothesized that ventilatory efficiency was poorer and that breathing patterns differed in EP−born compared to term−born individuals. Methods: Two area−based cohorts of participants born with gestational age ≤28 weeks or birth weight ≤1000 g in 1982−85 (n = 46) and 1991–92 (n = 35) were compared with individually matched controls born at term. Mean ages were 18 and 10 years, respectively. The participants performed an incremental treadmill exercise test to peak oxygen uptake with data averaged over 20 s intervals. For each participant, the relationship between exhaled minute ventilation (V˙E) and carbon dioxide output (V˙CO2) was described by a linear model, and the relationship between tidal volume (VT) and V˙E by a quadratic model. Multivariate regression analyses were done with curve parameters as dependent variables, and the categories EP vs. term−born, sex, age, height, weight and forced expiratory volume in 1 s (FEV1) as independent variables. Results: In adjusted analyses, the slope of the V˙E−V˙CO2 relationship was significantly steeper in the EP than the term-born group, whereas no group difference was observed for the breathing pattern, which was related to FEV1 only. Conclusion: EP-born participants breathed with higher V˙E for any given CO2 output, indicating lower ventilatory efficiency, possibly contributing to lower aerobic capacity. The breathing patterns did not differ between the EP and term−born groups when adjusted for FEV1.

• Røksund, Ola Drange; Heimdal, John-Helge; Clemm, Hege Synnøve Havstad; Vollsæter, Maria & Halvorsen, Thomas (2016). Exercise inducible laryngeal obstruction: diagnostics and management. Paediatric Respiratory Reviews. ISSN 1526-0542. 21, p. 86–94. doi: 10.1016/j.prrv.2016.07.003. Full text in Research Archive Show summary

  Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.

• Andersen, Tiina Maarit; Sandnes, Astrid; Brekka, Anne Kristine; Hilland, Magnus; Clemm, Hege Synnøve Havstad & Fondenes, Ove [Show all 11 contributors for this article] (2016). Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis. Thorax. ISSN 0040-6376. 72(3), p. 221–229. doi: 10.1136/thoraxjnl-2015-207555. Full text in Research Archive Show summary

  Background: Most patients with amyotrophic lateral sclerosis (ALS) are treated with mechanical insufflation–exsufflation (MI-E) in order to improve cough. This method often fails in ALS with bulbar involvement, allegedly due to upper-airway malfunction. We have studied this phenomenon in detail with laryngoscopy to unravel information that could lead to better treatment. Methods: We conducted a cross-sectional study of 20 patients with ALS and 20 healthy age-matched and sex-matched volunteers. We used video-recorded flexible transnasal fibre-optic laryngoscopy during MI-E undertaken according to a standardised protocol, applying pressures of ±20 to ±50 cm H2O. Laryngeal movements were assessed from video files. ALS type and characteristics of upper and lower motor neuron symptoms were determined. Results: At the supraglottic level, all patients with ALS and bulbar symptoms (n=14) adducted their laryngeal structures during insufflation. At the glottic level, initial abduction followed by subsequent adduction was observed in all patients with ALS during insufflation and exsufflation. Hypopharyngeal constriction during exsufflation was observed in all subjects, most prominently in patients with ALS and bulbar symptoms. Healthy subjects and patients with ALS and no bulbar symptoms (n=6) coordinated their cough well during MI-E. Conclusions: Laryngoscopy during ongoing MI-E in patients with ALS and bulbar symptoms revealed laryngeal adduction especially during insufflation but also during exsufflation, thereby severely compromising the size of the laryngeal inlet in some patients. Individually customised settings can prevent this and thereby improve and extend the use of non-invasive MI-E.

• Vollsæter, Maria; Skromme, Kaia; Satrell, Emma Elsa Carolina; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange & Øymar, Knut [Show all 8 contributors for this article] (2015). Children born preterm at the turn of the millennium had better lung function than children born similarly preterm in the early 1990s. PLOS ONE. 10:e0144243(12). doi: 10.1371/journal.pone.0144243. Full text in Research Archive Show summary

  OBJECTIVE: Compare respiratory health in children born extremely preterm (EP) or with extremely low birthweight (ELBW) nearly one decade apart, hypothesizing that better perinatal management has led to better outcome. DESIGN: Fifty-seven (93%) of 61 eligible 11-year old children born in Western Norway in 1999-2000 with gestational age (GA) <28 weeks or birthweight <1000 gram (EP1999-2000) and matched term-controls were assessed with comprehensive lung function tests and standardized questionnaires. Outcome was compared with data obtained at 10 years of age from all (n = 35) subjects born at GA <29 weeks or birthweight <1001 gram within a part of the same region in 1991-92 (EP1991-1992) and their matched term-controls. RESULTS: EP1999-2000 had significantly reduced forced expiratory flow in 1 second (FEV1), FEV1 to forced vital capacity (FEV1/FVC) and forced expiratory flow between 25-75% of FVC (FEF25-75), with z-scores respectively -0.34, -0.50 and -0.61 below those of the term-control group, and more bronchial hyperresponsiveness to methacholine (dose-response-slope 13.2 vs. 3.5; p<0.001), whereas other outcomes did not differ. Low birthweight z-scores, but not neonatal bronchopulmonary dysplasia (BPD) or low GA, predicted poor outcome. For children with neonatal BPD, important lung-function variables were better in EP1999-2000 compared to EP1991-1992. In regression models, improvements were related to more use of antenatal corticosteroids and surfactant treatment in the EP1999-2000. CONCLUSIONS: Small airway obstruction and bronchial hyperresponsiveness were still present in children born preterm in 1999-2000, but outcome was better than for children born similarly preterm in 1991-92, particularly after neonatal BPD. The findings suggest that better neonatal management not only improves survival, but also long-term pulmonary outcome.

• Vollsæter, Maria; Clemm, Hege Synnøve Havstad; Satrell, Emma Elsa Carolina; Eide, Geir Egil; Røksund, Ola Drange & Markestad, Trond [Show all 7 contributors for this article] (2015). Adult respiratory outcomes of extreme preterm birth. A regional cohort study. Annals of the American Thoracic Society. ISSN 2329-6933. 12(3), p. 313–322. doi: 10.1513/AnnalsATS.201406-285OC. Full text in Research Archive Show summary

  Rationale: Lifetime respiratory function after extremely preterm birth (gestational age ≤28 wk or birth weight ≤1,000 g) is unknown. Objectives: To compare changes from 18–25 years of age in respiratory health, lung function, and airway responsiveness in young adults born extremely prematurely to that of term-born control subjects. Methods: Comprehensive lung function investigations and interviews were conducted in a population-based sample of 25-year-old subjects born extremely prematurely in western Norway in 1982–1985, and in matched term-born control subjects. Comparison was made to similar data collected at 18 years of age. Measurements and Main Results: At 25 years of age, 46/51 (90%) eligible subjects born extremely prematurely and 39/46 (85%) control subjects participated. z-Scores for FEV1, forced expiratory flow at 25–75% of vital capacity, and FEV1/FVC were significantly reduced in subjects born extremely prematurely by 1.02, 1.26, and 0.88, respectively, and airway resistance (kPa/L/s) was increased (0.23 versus 0.18). Residual volume to total lung capacity increased with severity of neonatal bronchopulmonary dysplasia. Responsiveness to methacholine (dose–response slope; 3.16 versus 0.85) and bronchial lability index (7.5 versus 4.8%) were increased in subjects born extremely prematurely. Lung function changes from 18 to 25 years and respiratory symptoms were similar in the prematurely born and term-born groups. Conclusions: Lung function in early adult life was in the normal range in the majority of subjects born extremely prematurely, but methacholine responsiveness was more pronounced than in term-born young adults, suggesting a need for ongoing pulmonary monitoring in this population

• Clemm, Hege Synnøve Havstad; Vollsæter, Maria; Røksund, Ola Drange; Markestad, Trond & Halvorsen, Thomas (2015). Adolescents who were born extremely preterm demonstrate modest decreases in exercise capacity. Acta Paediatrica. ISSN 0803-5253. 104(11), p. 1174–1181. doi: 10.1111/apa.13080. Full text in Research Archive

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• Olsen-Hagen, Nicolay Morland; Tovi, David; Clarsen, Benjamin Matthew; Rygh, Cecilie Brekke; Bache-Mathiesen, Lena Kristin & Clemm, Hege Synnøve Havstad [Show all 7 contributors for this article] (2026). 33 Prevalence, incidence and risk factors of spondylolysis in youth football: a longitudinal study among male Norwegian players. BMJ Open sport & exercise medicine. 12(Suppl 1), p. A12–A12. doi: 10.1136/bmjsem-2026-sportskongres.33. Full text in Research Archive
• Rogde, Aase Johnsen; Kvidaland, Haakon Kristian; Lehmann, Sverre; Halvorsen, Thomas; Clemm, Hege Synnøve Havstad & Røksund, Ola Drange [Show all 8 contributors for this article] (2025). Exercise-induced laryngeal obstruction in a hospital-based cohort with asthma. doi: 10.1183/13993003.congress-2025.pa2587. Full text in Research Archive
• Brekka, Anne Kristine; Solli, Petrine Veierød; Indrekvam, Solfrid; Engeset, Merete Salveson; Røksund, Ola Drange & Lehmann, Sverre [Show all 11 contributors for this article] (2025). Laryngeal ultrasound to observe laryngeal movements during non-invasive ventilation in COPD. doi: https:/publications.ersnet.org/content/erj/66/suppl69/oa6546. Full text in Research Archive
• Solli, Petrine Veierød; Muralitharan, Praveen; Veseth, Sivert H.; Kvidaland, Haakon Kristian; Carlsen, Petter & Engeset, Merete Salveson [Show all 11 contributors for this article] (2025). A randomized controlled trial (RCT), adding inspiratory muscle training to standard treatment for exercise-induced laryngeal obstruction (EILO). Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2025). Beyond asthma - expanding the horizon of respiratory health in athletes. Full text in Research Archive
• Holmsve, Monica; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas & Stensrud, Trine (2025). From peak performance to post-retirement: Pulmonary changes in elite athletes. Full text in Research Archive
• Brekka, Anne Kristine; Indrekvam, Solfrid; Solli, Petrine Veierød; Engeset, Merete Salveson; Røksund, Ola Drange & Lehmann, Sverre [Show all 11 contributors for this article] (2024). Laryngeal observations during non-invasive ventilation titration in chronic obstructive pulmonary disease. doi: 10.1183/13993003.congress-2024.oa961. Full text in Research Archive
• Andersen, Tiina; Brekka, Anne Kristine; Fretheim-Kelly, Zoe; Lujan, Manel; Heimdal, John-Helge & Clemm, Hege Synnøve Havstad [Show all 11 contributors for this article] (2024). Upper airway and translaryngeal resistance during mechanical insufflation-exsufflation. doi: 10.1183/13993003.congress-2024.pa1434. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). When is asthma/EIB not asthma/EIB? - other causes. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Special investigations including direct and indirect provocative tests. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Special investigations including continious laryngoscopy during exercise. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Therapeutic options for athletes with EILO (with interactive sessions). Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Practical demonstration: Spirometry, exercise challenge test, EVH. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Practical demonstration: Performing the continious laryngoscopy during exercise (CLE) test. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). Recognition and clinical diagnosis of EILO in athletes - distinguishing EILO from asthma. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2024). When breathing goes wrong in athlete4s, and it is not asthma? Thinking outside the box to prevent impaired health and performance. Full text in Research Archive
• Bårdsen, Tonje; Røksund, Ola Drange; Eagan, Tomas Mikal Lind; Hufthammer, Karl Ove; Benestad, Merete Røineland & Clemm, Hege Synnøve Havstad [Show all 8 contributors for this article] (2023). Impaired Lung Function in Extremely Preterm-Born Adults in Their Fourth Decade of Life. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 208(4), p. 493–495. doi: 10.1164/rccm.202303-0448LE. Full text in Research Archive
• Clemm, Hege Synnøve Havstad (2023). Letter from Norway. Respirology (Carlton South. Print). ISSN 1323-7799. doi: 10.1111/resp.14478. Full text in Research Archive
• Brekka, Anne Kristine; Ntoumenopoulos, George; Røksund, Ola Drange; Engeseth, Merete Salveson; Engeset, Merete Salveson & Clemm, Hege Synnøve Havstad [Show all 9 contributors for this article] (2023). Strupens responser under non-invasiv ventilasjonsstøtte hos friske frivillige. Full text in Research Archive
• Olin, J Tod; Fredericson, Michael; Nichol, Cameron; Willick, Stuart E. & Clemm, Hege Synnøve Havstad (2022). Lessons learned from the Tokyo games isolation hotel experience. British Journal of Sports Medicine. ISSN 0306-3674. 56(11), p. 597–598. doi: 10.1136/bjsports-2021-105116. Full text in Research Archive
• Kvidaland, Haakon; Stadheim, Sandra; Bø, Signe; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange & Vollsæter, Maria [Show all 7 contributors for this article] (2022). Is it feasible to perform a continuous laryngoscopy exercise test with a cold air inhalate? A case report. European Respiratory Journal Open Research (ERJ Open Research). 8(4). doi: 10.1183/23120541.00222-2022. Full text in Research Archive
• Engan, Mette; Engeset, Merete Salveson; Engesæter, Ingvild Øvstebø; Gamlemshaug, Ole C. O.; Vollsæter, Maria & Halvorsen, Thomas [Show all 8 contributors for this article] (2020). Prevalence and consequences of left vocal cord paralysis in young adults born extremely premature with a history of neonatal patent ductus arteriosus surgery. Full text in Research Archive
• Halvorsen, Thomas; Clemm, Hege Havstad; Vollsæter, Maria & Røksund, Ola Drange (2020). Conundrums of exercise-related breathing problems. Epiglottic, laryngeal, or bronchial obstruction? American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 202(10), p. e142–e143. doi: 10.1164/rccm.201910-1921IM. Full text in Research Archive
• Engeseth, Merete Salveson; Engan, Mette; Clemm, Hege Synnøve Havstad; Nilsen, Roy Miodini; Vollsæter, Maria & Halvorsen, Thomas [Show all 7 contributors for this article] (2019). Respiratory- and voice symptoms among extremely preterm born children with prolonged ventilator dependency. A Norwegian national cohort study. Full text in Research Archive
• Andersen, Tiina Maarit; Sandnes, Astrid; Fondenes, Ove; Clemm, Hege Synnøve Havstad; Halvorsen, Thomas & Nilsen, Roy Miodini [Show all 10 contributors for this article] (2018). Laryngoscopy Can Be a Valuable Tool for Unexpected Therapeutic Response in Noninvasive Respiratory Interventions. Respiratory care. ISSN 0020-1324. 63(11), p. 1459–1461. doi: 10.4187/respcare.06674. Full text in Research Archive
• Jansrud, Ida; Bovim, Lars Peder Vatshelle; Vollsæter, Maria; Røksund, Ola Drange; Halvorsen, Thomas & Clemm, Hege Synnøve Havstad (2018). Is continuous laryngoscopy during cardiopulmonary exercise testing reliable for measuring maximum oxygen uptake? Full text in Research Archive
• Hestnes, Julie; Hoel, Hedda B; Røksund, Ola Drange; Frisk, Bente; Thorsen, Einar & Halvorsen, Thomas [Show all 8 contributors for this article] (2016). Ventilatory efficiency in children and adolescents born extremely preterm. European Respiratory Journal. ISSN 0903-1936. 48. doi: 10.1183/13993003.congress-2016.PA1223. Full text in Research Archive
• Engeseth, Merete Salveson; Røksund, Ola Drange; Vollsæter, Maria; Halvorsen, Thomas & Clemm, Hege Synnøve Havstad (2016). Respiratory morbidity in extremely premature born children and later physical Activity. Full text in Research Archive
• Andersen, Tiina Maarit; Sandnes, Astrid; Brekka, Anne Kristine; Vollsæter, Maria; Hilland, Magnus & Halvorsen, Thomas [Show all 11 contributors for this article] (2015). Hvordan reagerer strupen ved bruk av hostemaskin hos personer med amyotrofisk lateral sklerose? Full text in Research Archive
• Sandnes, Astrid; Andersen, Tiina Maarit; Vollsæter, Maria; Fondenes, Ove; Røksund, Ola Drange & Halvorsen, Thomas [Show all 7 contributors for this article] (2015). Lung function and respiratory muscle strength in Amyotrophic Lateral Sclerosis. Full text in Research Archive
• Engeseth, Merete Salveson; Clemm, Hege Synnøve Havstad; Røksund, Ola Drange; Øymar, Knut; Markestad, Trond & Halvorsen, Thomas [Show all 7 contributors for this article] (2015). Better respiratory outcomes for extremely preterm born children. Full text in Research Archive
• Andersen, Tiina Maarit; Sandnes, Astrid; Brekka, Anne Kristine; Hilland, Magnus; Clemm, Hege Synnøve Havstad & Fondenes, Ove [Show all 11 contributors for this article] (2015). Laryngeal response patterns to mechanical assisted cough in Amyotrophic Lateral Sclerosis. Full text in Research Archive
• Andersen, Tiina Maarit; Sandnes, Astrid; Brekka, Anne Kristine; Vollsæter, Maria; Hilland, Magnus & Halvorsen, Thomas [Show all 11 contributors for this article] (2015). Laryngeal response patterns to mechanical insufflation-exsufflation in amyotrophic lateral sclerosis. Full text in Research Archive
• Clemm, Hege Synnøve Havstad; Halvorsen, Thomas; Markestad, Trond & Røksund, Ola Drange (2015). Exercise Capacity after Extremely Preterm birth. PhD Thesis. Universitetet i Bergen. Full text in Research Archive
• Clemm, Hege Synnøve Havstad & Halvorsen, Thomas (2015). Exercise Capacity after extremely preterm birth. Development from childhood to adulthood. Universitetet i Bergen. ISSN 9788230825822. Full text in Research Archive Show summary

  Background: Extremely preterm (EP) birth is associated with a series of adverse health outcomes, some of which may be alleviated by improved physical fitness. Subjects born EP are reportedly less physically active than term-born peers, measures of exercise capacity are poorly described and longitudinal changes are unknown. Aims: To investigate associations between EP birth and exercise capacity in later life. Methods: Two area-based cohorts born at gestational age ≤ 28 weeks or with birth weight ≤ 1000 grams in 1991-1992 and in 1982–1985 were examined at 10 and 18 and at 18 and 25 years of age together with matched term-born controls using an identical maximal cardio-pulmonary treadmill exercise-test and validated questionnaires. The main outcome variables were maximal oxygen consumption and the distance completed at the exercise test. Main Results: Measures of exercise capacity was decreased by approximately 10% in EP-born compared to matched term-born control groups; however, with mean values within levels considered normal. Differences between EP-born and term-born controls were largely explained by differences between the males, but this apparent gender difference did not reach statistical significance when tested with interaction terms. Changes in exercise capacity from 10 to 18 and from 18 to 25 years of age did not differ from what was observed for term-born controls. A neonatal history of surgical closure of a patent ductus arteriosus was a risk factor for left-sided laryngeal paralysis with an associated increased risk of respiratory symptoms and airway obstruction, but exercise capacity was not reduced. A neonatal history of bronchopulmonary dysplasia was unrelated to current measures of exercise capacity, and we were unable to disentangle strong associations between neonatal factors and later exercise capacity. Current FEV1 was unrelated to measures of exercise capacity. At 10 years of age, no associations were observed between reported physical activity and peakV̇ O2, whereas at older ages these two variables were significantly and positively associated in both the EP-born and term-born groups in both participating birth-cohorts. Conclusion: Mean exercise capacity was approximately 10% poorer in EP-born than term-born participants; however, values were basically normal and unrelated to most neonatal factors and to current FEV1. Changes from mid childhood to adulthood were parallel in the EP-and term-born groups. A positive association between exercise capacity and self-reported physical activity developed through puberty in both the EP and term-born groups, suggesting similar trainability.

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