P211 Comorbidity between asthma, inducible laryngeal obstruction and breathing pattern disorder

Slinger, Claire; Wilson, Hannah; Vyas, Aashish; Slinger, Richard

doi:10.1136/thorax-2019-btsabstracts2019.354

Cited by 2 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They can be referred to as “enhancers.” These typically promote vocal cord closure, usually as a protective reflex in the first instance. The most common enhancers in pediatrics are extra-esophageal reflux (i.e., where reflux of gastric contents impacts beyond the esophagus), nasal obstruction and asthma ( 18 ).…”

Section: Methodsmentioning

confidence: 99%

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

et al. 2020

View full text Add to dashboard Cite

Dysfunctional breathing (DB) is an overarching term describing deviations in the normal biomechanical patterns of breathing which have a significant impact on quality of life, performance and functioning. Whilst it occurs in both children and adults, this article focuses specifically on children. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO). They can be considered in isolation, however, are intricately related and often co-exist. When both are suspected, we propose both BPD and ILO be investigated within an all-encompassing multidisciplinary dysfunctional breathing clinic. The MDT clinic can diagnose DB through expert history taking and a choice of appropriate tests/examinations which may include spirometry, breathing pattern analysis, exercise testing and laryngoscopic examination. Use of the proposed algorithm presented in this article will aid decision making regarding choosing the most appropriate tests and understanding the diagnostic implications of these tests. The most common symptoms of DB are shortness of breath and chest discomfort, often during exercise. Patients with DB typically present with normal spirometry and an altered breathing pattern at rest which is amplified during exercise. In pediatric ILO, abnormalities of the upper airway such as cobblestoning are commonly seen followed by abnormal activity of the upper airway structures provoked by exercise. This may be associated with a varying degree of stridor. The symptoms, however, are often misdiagnosed as asthma and the picture can be further complicated by the common co-presentation of DB and asthma. Associated conditions such as asthma, extra-esophageal reflux, rhinitis, and allergy must be treated appropriately and well controlled before any directed therapy for DB can be started if therapy is to be successful. DB in pediatrics is commonly treated with a course of non-pharmaceutical therapy. The therapy is provided by an experienced physiotherapist, speech and language therapist or psychologist depending on the dominant features of the DB presentation (i.e., BPD or ILO in combination or in isolation) and some patients will benefit from input from more than one of these disciplines. An individualized treatment program based on expert assessment and personalized goals will result in a return to normal function with reoccurrence being rare.

show abstract

Section: Methodsmentioning

confidence: 99%

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Broadly, speech and language therapy treatment strategies for ILO include supporting an individual's understanding and acceptance of their diagnosis, optimising throat health, breathing techniques, laryngeal relaxation and psychosocial support (Dunn et al., 2015; Haines et al., 2018; Kenn & Balkissoon, 2011). Furthermore, respiratory SLTs commonly work alongside physiotherapists who specialise in managing breathing pattern disorder, which can co‐exist with ILO, often warranting concurrent interventions (Slinger et al., 2019). There is also evidence to support that some patients who make limited progress with SLT, find benefit in laryngeal botox (Baxter et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Applying behaviour change theory to speech and language therapy intervention for inducible laryngeal obstruction

Butler

Asbridge

Stringer

2023

Intl J Lang & Comm Disor

View full text Add to dashboard Cite

BackgroundSpeech and language therapists (SLTs) provide interventions for inducible laryngeal obstruction (ILO) despite a current lack of evidence to inform intervention delivery. This study is the first step to develop an evidence‐based intervention for ILO, using behaviour change theory and the Behaviour Change Technique Taxonomy version 1 (BCTTv1). Outcomes will inform the early development stage of a complex speech and language therapy intervention for ILO, enabling more precise reporting of ILO intervention studies, as per CONSORT guidelines.Aims(1) To identify whether the BCTTv1 is a useful tool for characterising speech and language therapy interventions for ILO, based on existing literature, current practice and patient interviews. (2) To identify key behaviour change techniques (BCT) used within existing complex speech and language therapy interventions for ILOMethods and ProceduresA five‐phase study was conducted: (1) a systematic literature search of six electronic databases (Medline, EMBASE, CINAHL (EBSCO), Scopus, Trip, Web of Science) and grey literature between 2008 and 2020; (2) observations of six speech and language therapy intervention sessions; (3) a semi‐structured interview with an SLT to validate the observed BCTTs; (4) consensus from four national expert SLTs regarding application of synthesised BCTT data to their own experiences of ILO interventions; and (5) patient engagement to review and comment on findings.Outcomes and ResultsForty‐seven BCTs in total were coded across all three sources. Thirty‐two BCTs were identified in clinical observations; 31 in interviews with SLTs and 18 in the literature. Only six BCT were identified in all three sources. Expert SLTs confirmed clinical application and relevance. Patients reported finding the concept of BCT challenging but highlighted the value of psychoeducation to support their understanding of symptoms and in turn to understand the rationale behind speech and language therapy intervention recommendations.ConclusionThis study indicates that the BCTTv1 is a suitable framework to identify and describe intervention components used within speech and language therapy interventions for ILO. A practice–research gap exists, reinforcing that existing literature does not capture the complexity of speech and language therapy intervention for ILO. Further research is needed to develop our understanding of the BCTs that support optimal behaviour change for this patient group.What this paper addsWhat is already known on the subject There is growing recognition for the value of speech and language therapists (SLTs) in delivering complex interventions for patients with inducible laryngeal obstruction (ILO), including evidence to suggest that their intervention can improve quality of life for patients and reduce excessive healthcare use. There are, however, no randomised controlled trials in this field; thus it is unclear what constitutes the most effective intervention.What this study adds This study demonstrates the complexity of speech and language therapy interventions for ILO and highlights the practice–research gap. It identifies a range of behaviour change techniques that are used in existing practice and captures patient views relating to the components identified within this study.What are the clinical implications of this work? Findings highlight the value of providing education about factors that might be driving ILO symptoms and in turn the importance of sharing with patients the rationale for treatment recommendations that necessitate a change in their behaviours. Identified behaviour change techniques can be used when developing and implementing SLT interventions for ILO.

show abstract

P211 Comorbidity between asthma, inducible laryngeal obstruction and breathing pattern disorder

Cited by 2 publications

References 0 publications

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

Applying behaviour change theory to speech and language therapy intervention for inducible laryngeal obstruction

Contact Info

Product

Resources

About