Primary Concern: Piloting a novel direct pathway from Primary Care to a Tertiary Airways service for patients with suspected Inducible Laryngeal Obstruction (ID 483)
Lancashire Teaching Hospitals NHS Trust
Funding: None
Abstract
Inducible laryngeal obstruction (ILO) is an inappropriate, unexpected closure of the vocal folds on inspiration, with associated symptoms including breathlessness, throat tightness, respiratory distress, and cough. Patients are often misdiagnosed and treated for asthma, with associated morbidity and high healthcare utilisation. Diagnosis of ILO can be challenging, and it can take many years before referral to a specialist centre.Referrals to our tertiary airways service originate from secondary care. A primary care respiratory MDT engaged in a pilot to refer patients with suspected ILO directly to speech and language therapy (SLT) in our service to review if this would lead to expedited diagnosis.
Aim:
Review outcomes of patients referred from the primary care respiratory network over a 12 month period. We hypothesized that primary care patients would have shorter time from symptom onset to referral, fewer respiratory complaints, and lower medication burden than referrals from secondary care.
Method:
A screening proforma captured clinical characteristics associated with ILO. Primary care patients were reviewed by a respiratory physician in the community MDT and seen by SLT within the tertiary centre. Patients exhibiting signs suggestive of ILO (n=10) were assessed via video laryngoscopy. Data were compared with a consecutive sample of patients (n=10) referred from secondary care.
Results:
No differences between groups were found for age, gender or BMI. Primary care patients had fewer respiratory comorbidities, fewer prescribed medications, and less time from onset of symptoms to referral. Similar rates of ILO diagnosis were given for the two groups. There were no reported adverse effects.
Conclusions:
To our knowledge, this is the first pilot of direct to tertiary service SLT for assessment for ILO. Further opinion will be gathered as to patient experience of this innovation. Benefits included the potential to reduce polypharmacy and morbidity and length of pathway to secure accurate diagnosis.
Conflicts of interest: None
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