Laryngospasm: what it is, what triggers it and what to do

The larynx, or voice box, contains the vocal cords, which open to let air in and close to protect the airway. In laryngospasm the cords snap shut as you breathe in. Frimley Health describes this as blocking the flow of air into the lungs, and says that when the cords spasm they can fully or partially close the airway.

There are two broad settings. The first is outside hospital, where it can occur during the day or while asleep and is often linked to irritants, reflux or breathing conditions. The second is during or just after general anaesthesia, which the Association of Anaesthetists of Great Britain and Ireland covers in its anaesthetic emergencies handbook and which is handled by the anaesthetic team, not by the patient.

Frimley lists the main symptoms as sudden difficulty inhaling with no obvious cause, a sensation of choking and a feeling of tightness in the throat. People with the condition can wake in the middle of the night unable to speak or breathe, which understandably causes fear.

The anaesthetic guideline notes that stridor, a noisy high-pitched sound on breathing in, is a sign associated with laryngospasm, although it can have other causes. It also lists conditions that can mimic laryngospasm, including a foreign body, infection of the larynx or upper respiratory tract, anaphylaxis, an airway tumour and vocal cord paralysis. That is one reason new or persistent breathing noises deserve proper assessment.

• Sudden inability to breathe in, often with a choking sensation.

• Tight throat, difficulty speaking during the episode.

• Waking from sleep unable to breathe or speak.

• A high-pitched noise when breathing in (stridor).

Frimley lists asthma and allergies, exercise, irritants (smoke, fumes, dust), stress and anxiety, reflux (indigestion) and nasal disease as triggers. Identifying your own pattern, such as episodes after late meals, after exposure to fumes or during a cold, can help your clinician choose which cause to treat.

In anaesthesia, the handbook describes stimulation of the airway during a light plane of anaesthesia, with the guidance listing removal of anything that may be stimulating or obstructing the airway, such as suction catheters, blood or vomit.

Frimley's speech and language therapy leaflet advises remaining calm, because panicking can make a spasm last longer. During a spasm, try not to gasp for air or gulp in through the mouth; if possible sit down, relax your shoulders and remind yourself that the event will pass. Try breathing in through the nose with the mouth closed, which it says goes against natural instinct but relaxes the vocal cords. If this is not helping, focus on breathing out through pursed lips.

It also describes breathing in and out slowly through a straw, sealing the lips around it, or through pursed lips, as techniques that encourage slower breathing and help relax the vocal cords. The leaflet states that the spasm will always relax and that breathing should return to normal once the attack has passed.

Frimley says that if you have a persistent problem with your breathing you should seek medical attention. See a GP if episodes recur, because treating triggers such as reflux, asthma, allergy or nasal disease may reduce them, and a referral to a speech and language therapist or ENT specialist can be arranged. Call 999 if you cannot breathe or speak, if lips or skin turn blue or grey, or if someone loses consciousness.

Breathing difficulty that is not a short, self-resolving episode, or is accompanied by chest pain, wheeze, swelling of the face or tongue or a rash, should be treated as an emergency.

On the NHS the route is usually the GP, then ENT or respiratory clinics and speech and language therapy for breathing retraining. Private ENT and speech therapy appointments are available and offer similar assessment, but the key step is the same: find and treat the trigger, and learn the breathing techniques before the next episode.