Breathing better: How combining respiratory services is helping patients faster

Kate Baumwol & Dr John Blakey develop Intervention Clinic

One of the top reasons for emergency department admissions is for severe coughing and a sudden difficulty to breathe – both an indicator of serious illnesses such as lung cancer, asthma and interstitial lung disease.

However, there can be another cause, says SCGH Senior Speech Pathologist Kate Baumwol, inducible laryngeal obstruction, which is an abnormal narrowing at the level of the larynx during inspiration, and very often confused as asthma.

Baumwol says the misdiagnosis of asthma can often lead to patients being treated with expensive and ineffective drugs, and patients being readmitted multiple times due to the ongoing symptoms.

“You have a significant struggle with breathing with laryngeal obstruction, and so there is a lot of panic, particularly as it can have such rapid onset,” said Baumwol.

“The larynx is closing on inspiration when it’s meant to be completely open to allow air in. A lot of these patients end up in ICU, some get intubated. There’s usually a two-year delay in getting the current diagnosis. However, with the correct diagnosis and appropriate treatment through speech pathology, it’s very treatable in a short timeframe.”

“We were seeing respiratory patients referred to us that might be seen by a medical team six times before they reached speech pathology, and we would essentially fix them in one session. The thinking was to make sure we were involved earlier.”

Baumwol, along with Dr John Blakey, developed the SCGH Joint Speech Pathology & Airway Clinic and Intervention Voice Clinic, in essence bringing nursing, respiratory and speech pathology specialties under one roof.

This has enabled the Clinic to take a transdisciplinary approach, with each understanding what questions the other might ask a patient at an initial consultation, and enabling faster referral for the patient to the care they need.

“We’ve been able to create a significant reduction in occasions of service for these patients, and we’re getting them the right help faster. Previously some patients were having up to nine respiratory occasions of service before being treated. Now, patients are being triaged on referral and are seen immediately in the Clinic.”

“So that’s a huge improvement for the care and wellbeing of those patients and is actively reducing the pressure on the hospital by getting the patients to the care they need, faster.”

June is one of these patients, sceptical at first, after already being diagnosed with asthma, June was referred to a respiratory specialist earlier this year. A few months later after seeing the specialist, June was referred to the Clinic after the specialist expressed concern that she may have inducible laryngeal obstruction, which presents with similar symptoms to asthma.

“I was grateful for the efficiency of the Clinic due to the department crossover – it was amazing. They gave me a real understanding of my condition and after suffering from a chronic condition for so long finding a way of improving my health was a relief. Kate gave me breathing exercises to work on before my next appointment and further clarity on the next steps.”

“The follow up appointment with Kate was invaluable. I gained further understanding of inducible laryngeal obstruction and reviewed my breathing technique which I had been practicing daily. I have already noticed a difference with the easing of asthma symptoms and less reliance on my asthma medication, both the Respiratory and Speech Departments have helped me so much already.” said June.

The Foundation recently provided the Joint Speech Pathology & Airway Clinic with a $5,000 grant to help them update their database, a critical piece of infrastructure built by Respiratory Medicine Consultant, Dr Alice Crawford, to ensure great data is collected around a little-known issue.

“That grant was invaluable as it helps us to keep expanding and building on our work,” says Baumwol. “There is very little information about the prevalence of inducible laryngeal obstruction in the wider population.”

“As well as enhancing our patient treatment, the Clinic’s co-learning approach with speech pathology and respiratory services is giving us data sets and an opportunity to open the door to more research and solutions to improve outcomes for patients.”