Hege Clemm

• 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. ISSN 2079-9292. 13(10). doi: 10.3390/electronics13101880.
• Carlsen, Petter Helø; 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. ISSN 2055-7647. 10(2). doi: 10.1136/bmjsem-2023-001850.
• 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. doi: 10.1016/j.prrv.2024.02.002.
• 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.
• 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.
• 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. ISSN 2044-6055. 13(6). doi: 10.1136/bmjopen-2022-071159. 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). ISSN 2312-0541. 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.

• 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). ISSN 2312-0541. doi: 10.1183/23120541.00222-2022.
• 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.
• 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
• 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. ISSN 2044-6055. 12(5), p. 1–7. doi: 10.1136/bmjopen-2021-059234.
• 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.

• 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
• 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.

• 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. ISSN 2296-2360. 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.

• 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
• 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). ISSN 2312-0541. 8(1), p. 1–9. doi: 10.1183/23120541.00581-2021. Full text in Research Archive
• 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. ISSN 2296-2360. 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.

• 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. ISSN 2296-2360. 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.

• 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.
• 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.
• 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
• 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
• 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).

• 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. ISSN 2051-817X. 9(22), p. 1–10. doi: 10.14814/phy2.15086. 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. ISSN 2296-2360. 9, p. 1–7. doi: 10.3389/fped.2021.617759. Full text in Research Archive
• 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). ISSN 2312-0541. 7(1), p. 1–9. doi: 10.1183/23120541.00825-2020. Full text in Research Archive
• Engan, Mette; Jansrud, Ida; Stensrud, Trine; Gundersen, Hilde; Edvardsen, Elisabeth & Clemm, Hege Havstad (2020). Pust opp Stolzen. Norsk idrettsmedisin. ISSN 0806-9328.
• 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
• 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.
• 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. ISSN 2055-7647. 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.

• 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. ISSN 2296-2360. 8. doi: 10.3389/fped.2020.00150. Full text in Research Archive
• 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. ISSN 2296-875X. 6(44), p. 1–9. doi: 10.3389/fsurg.2019.00044. Full text in Research Archive
• 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. ISSN 1664-042X. 10:1333, p. 1–10. doi: 10.3389/fphys.2019.01333. Full text in Research Archive
• 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
• 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. ISSN 2399-9772. 3:e000481, p. 1–11. doi: 10.1136/bmjpo-2019-000481. Full text in Research Archive
• 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. ISSN 2055-7647. 5(1), p. 1–8. doi: 10.1136/bmjsem-2018-000436. Full text in Research Archive
• 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
• Clemm, Hege Synnøve Havstad & Røksund, Ola Drange (2018). Pusteproblemer under anstrengelse. Paidos: Tidsskrift for Norsk barnelegeforening. ISSN 1503-5360. 38(3), p. 108–109.
• 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.
• 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.
• 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.
• 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
• 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. ISSN 1664-042X. 8. doi: 10.3389/fphys.2017.00499. 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] (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
• 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
• 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. 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

• 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. ISSN 1932-6203. 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.

• 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.
• Clemm, Hege Synnøve Havstad; Vollsæter, Maria; Røksund, Ola Drange; Eide, Geir Egil; Markestad, Trond & Halvorsen, Thomas (2014). Exercise capacity after extremely preterm birth: Development from adolescence to adulthood. Annals of the American Thoracic Society. ISSN 2329-6933. 11(4), p. 537–545. doi: 10.1513/AnnalsATS.201309-311OC. Show summary

  Rationale: Extremely preterm (EP) birth is associated with a series of adverse health outcomes, some of which may be alleviated by improved physical fitness. However, EP-born subjects are reportedly less physically active than term-born peers. Exercise capacity is poorly described in this group, and longitudinal data are needed. Objectives: To compare exercise capacity of adults born EP and at term, and to address developmental patterns from adolescence to adulthood. Methods: An area-based cohort of adults, born in 1982–1985 at gestational age 28 weeks or earlier, or with birth weight of 1,000 g or less, originally examined at 18 years of age, were re-examined at 25 years of age together with individually matched term-born control subjects, using an identical maximal cardiopulmonary treadmill exercise test and validated questionnaires. Measurements and Main Results: A total of 34 (76%) eligible preterm and 33 (85%) term control subjects successfully completed the exercise test at age 25 years. In the two groups, average (95% confidence interval) peak oxygen consumption was 40.7 (37.9–43.5) and 44.2 (41.0–47.4) ml ⋅ kg−1⋅min−1, respectively, whereas the distance completed on the treadmill was 910 (827–993) m and 1,020 (927–1,113) m. Peak oxygen consumption was unrelated to neonatal factors and current FEV1, but was positively associated with leisure-time physical activity and negatively associated with age at examination. Values obtained at age 18 and 25 years were strongly correlated and within normal range at both examinations. Conclusions: Exercise capacity was modestly reduced in EP-born adults; however, values were within a normal range, positively associated with self-reported physical activity and unrelated to neonatal factors and current airway obstruction.

• Havstad, Hege Synnøve; Røksund, Ola Drange; Thorsen, Einar; Eide, Geir Egil; Markestad, Trond & Halvorsen, Thomas (2012). Aerobic capacity and exercise performance in young people born extremely preterm. Pediatrics. ISSN 0031-4005. 129(1), p. E97–E105. doi: 10.1542/peds.2011-0326.
• Røksund, Ola Drange; Havstad, Hege Synnøve; Heimdal, John-Helge; Aukland, Stein Magnus; Sandvik, Lorentz & Markestad, Trond [Show all 7 contributors for this article] (2010). Left vocal cord paralysis after extreme preterm birth, a new clinical scenario in adults. Pediatrics. ISSN 0031-4005. 126(6), p. E1569–E1577. doi: 10.1542/peds.2010-1129.

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• 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.
• 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.
• 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). ISSN 2312-0541. 8(4). doi: 10.1183/23120541.00222-2022.
• 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.
• 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.
• 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.
• 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.
• 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. .
• 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?
• 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.
• 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. .
• 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.
• 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.
• 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.
• 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.
• 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.
• 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?
• Vollsæter, Maria; Clemm, Hege Synnøve Havstad; Thorsen, Einar; Øymar, Knut; Røksund, Ola Drange & Markestad, Trond [Show all 7 contributors for this article] (2014). Alveolar nitric oxide(NO)in children born extremely preterm (EP).
• Clemm, Hege Synnøve Havstad; Vollsæter, Maria; Hilland, Magnus; Sandnes, Astrid; Sandvik, Lorentz & Halvorsen, Thomas [Show all 8 contributors for this article] (2014). Exercise induced laryngeal obstruction(EILO)diagnosed with laryngoscopy during rest or during exercise?
• Campos, Carolina; Røksund, Ola Drange; Vollsæter, Maria; Heimdal, John-Helge; Halvorsen, Thomas & Clemm, Hege Synnøve Havstad (2014). Exercise induced inspiratory symptoms.
• Vollsæter, Maria; Clemm, Hege Synnøve Havstad; Heimdal, John-Helge; Halvorsen, Thomas & Røksund, Ola Drange (2014). Spirometry- a tool for diagnosing exercise induced laryngeal obstruction (EILO)?
• Vollsæter, Maria; Clemm, Hege Synnøve Havstad; Heimdal, John-Helge; Halvorsen, Thomas & Røksund, Ola Drange (2014). Exercise Induced Inspiratory Stridor (EIIS) - A growing Challenge during Physical activity.
• Clemm, Hege Synnøve Havstad; Vollsæter, Maria; Røksund, Ola Drange; Halvorsen, Thomas & Heimdal, John-Helge (2014). Exercise induced inspiratory stridor (EIIS) in athletes.
• Clemm, Hege Synnøve Havstad; Halvorsen, Thomas; Markestad, Trond & Røksund, Ola Drange (2015). Exercise Capacity after Extremely Preterm birth. PhD Thesis. Universitetet i Bergen.
• Clemm, Hege Synnøve Havstad & Halvorsen, Thomas (2015). Exercise Capacity after extremely preterm birth. Development from childhood to adulthood. Universitetet i Bergen. ISSN 978-82-308-2582-2.

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