Can patient factors predict response to speech and language therapy for inducible laryngeal obstruction?

Slinger, Claire and Vyas, Aashish and Slinger, Richard and Blakemore, Jessica (2018) Can patient factors predict response to speech and language therapy for inducible laryngeal obstruction? Thorax, 73 (Suppl ). ISSN 0040-6376

Abstract

Introduction Inducible laryngeal obstruction (Ilo) is defined as an inappropriate adduction of the larynx on inspiration. Speech and language therapy (SLT) is viewed as the cornerstone of treatment of Ilo. Clinical consensus indicates that the optimal number of SLT sessions is between four and six. Our previous research has shown that% Forced Vital Capacity (% FVC) is a reliable predictor of Ilo in patients with breathlessness referred to our tertiary airways service (ERS Congress, 2017). In our current research, we aimed to investigate whether% FVC and other patient factors can predict improvement in Ilo symptoms following SLT intervention. Methods Data were analysed from 59 patients presenting to our service with symptoms of breathlessness. All had a diagnosis of Ilo via videolaryngoscopy and received SLT treatment. Analyses investigated relationships between improvement on Ilo symptoms and% FVC as well as other patient details. The VCDQ, a validated questionnaire measuring Ilo symptoms and response to SLT, was used pre- and post-therapy to assess improvement. Results VCDQ scores decreased following SLT for forty (68%) patients, demonstrating improvement. Of patients who improved, the mean number of SLT sessions was four, with the majority (60%) attending three to five sessions. No relationships were found between post-SLT improvement on the VCDQ and patient factors including age, gender, and potential co-morbidities such as asthma, GORD and rhinitis. There was a significant relationship between% FVC and VCDQ improvement (r=0.346, n=51, p=0.01). A binary logistic regression assessed the impact of% FVC on VCDQ improvement. The model was significant (χ 2=6.337 (1, n=59) p=0.012), and explained between 12% and 16% of the variance in improvement, correctly classifying 69% of cases. Patients with higher% FVC were five times more likely to show improvement on the VCDQ following SLT. Conclusions In line with clinical consensus, 3 to 5 sessions of SLT were sufficient to lead to improvements on VCDQ scores for the majority of patients. Patient demographic data did not predict improvements in Ilo following SLT, however% FVC may be a predictor of good treatment response to SLT for Ilo.