Page 57 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 57
It can be seen that the Asthma Specialist The Asthma Psychologist 57
Physiotherapist may effectively support a va-
riety of needs for the difficult asthma patient. Psychological comorbidity such as depression the multi-disciplinary team approach to specialist adult difficult asthma care
A recent systematic review has supported that and anxiety affects at least 1/3 of patients with
concept demonstrating the benefits of a range difficult asthma.22 Psychological comorbidity
of physiotherapy inputs to asthma care.94 in asthma has been shown to associate with
worse asthma and psychological outcomes as
Speech & Language Therapist well as impaired quality of life.98-103 Clear un-
derstanding of the impact of such health is-
Inducible laryngeal obstruction/ vocal cord sues upon the multimorbid disease model of
dysfunction (ILO/VCD) is a “middle air- difficult asthma remains to be defined. That it
way” disorder characterised by involuntary is likely to have significant impact is suggested
narrowing of the vocal folds predominant- by previous findings from our Institution.104
ly during inspiration. It gives rise to symp- In a retrospective study of patients repeatedly
toms of breathing difficulty including breath- hospitalised with acute asthma in a 12 month
lessness, voice change, and may be associated period, 69.4% had a known psychiatric diag-
with the phenomenon of upper airway or nosis alongside frequent other comorbidities
glottic wheeze. It may act as a mimic for asth- including dysfunctional breathing and obesi-
ma symptoms but has been demonstrated to ty. Such patients accounted for a dispropor-
be present as an aggravating comorbidity in tionately high number of bed days and associ-
15-30% of difficult asthma patients.22,37 Diag- ated healthcare costs.
nosis ideally requires an MDT approach with
input from Asthma Specialist Physician, Asth- The Asthma Psychologist can create a
ma Nurse Specialist, Asthma Specialist Phys- personalised approach to support the psycho-
iotherapist, Otolaryngologist plus Speech logical needs of the difficult asthma patient.
and Language Therapist. Clinical assessment A variety of processes might be utilised in-
alone might miss the diagnosis which ideally cluding mindfulness therapies and cognitive
rests on objective visualisation of the dynam- behavioural therapies. Mindfulness practice
ic laryngeal abnormalities at laryngoscopy.95 is centred on non-judgemental acknowledge-
An alternative empirical diagnostic pathway ment of experiences in order to reduce anx-
based around MDT consensus has been pro- iety and depression.105 A randomised control
posed due to restrictions around undertak- trial (RCT) of mindfulness-based stress re-
ing laryngoscopy during the Covid-19 pan- duction, found improved quality of life and
demic.96 Management approaches remain to less perceived stress across 42 patients with
be validated for ILO in the setting of difficult mild, moderate and severe asthma (compared
asthma. MDT approaches revolving around against a control intervention).106 The feasibil-
the input of a speech and language therapist ity and positive impact of delivering such in-
nevertheless show efficacy and are often the terventions in a group setting has been shown
mainstay of treatment in centres specialising in a recent pilot observational study.107 Cogni-
in this condition.97 These typically employ a tive Behavioural Therapy (CBT) provides an-
multicomponent approach that includes pa- other avenue for the Asthma Psychologist to
tient education, strategies to reduce larynge- support patients with difficult asthma. This
al irritation and tension plus elements of psy- focuses on stopping negative thought cycles
chological and physiotherapy support where associated with an overwhelming complex is-
appropriate. sue such as difficult asthma by breaking that
down into smaller parts that be more readi-
ly addressed. A Cochrane review of CBT in
persistent asthma demonstrated some
Physiotherapist may effectively support a va-
riety of needs for the difficult asthma patient. Psychological comorbidity such as depression the multi-disciplinary team approach to specialist adult difficult asthma care
A recent systematic review has supported that and anxiety affects at least 1/3 of patients with
concept demonstrating the benefits of a range difficult asthma.22 Psychological comorbidity
of physiotherapy inputs to asthma care.94 in asthma has been shown to associate with
worse asthma and psychological outcomes as
Speech & Language Therapist well as impaired quality of life.98-103 Clear un-
derstanding of the impact of such health is-
Inducible laryngeal obstruction/ vocal cord sues upon the multimorbid disease model of
dysfunction (ILO/VCD) is a “middle air- difficult asthma remains to be defined. That it
way” disorder characterised by involuntary is likely to have significant impact is suggested
narrowing of the vocal folds predominant- by previous findings from our Institution.104
ly during inspiration. It gives rise to symp- In a retrospective study of patients repeatedly
toms of breathing difficulty including breath- hospitalised with acute asthma in a 12 month
lessness, voice change, and may be associated period, 69.4% had a known psychiatric diag-
with the phenomenon of upper airway or nosis alongside frequent other comorbidities
glottic wheeze. It may act as a mimic for asth- including dysfunctional breathing and obesi-
ma symptoms but has been demonstrated to ty. Such patients accounted for a dispropor-
be present as an aggravating comorbidity in tionately high number of bed days and associ-
15-30% of difficult asthma patients.22,37 Diag- ated healthcare costs.
nosis ideally requires an MDT approach with
input from Asthma Specialist Physician, Asth- The Asthma Psychologist can create a
ma Nurse Specialist, Asthma Specialist Phys- personalised approach to support the psycho-
iotherapist, Otolaryngologist plus Speech logical needs of the difficult asthma patient.
and Language Therapist. Clinical assessment A variety of processes might be utilised in-
alone might miss the diagnosis which ideally cluding mindfulness therapies and cognitive
rests on objective visualisation of the dynam- behavioural therapies. Mindfulness practice
ic laryngeal abnormalities at laryngoscopy.95 is centred on non-judgemental acknowledge-
An alternative empirical diagnostic pathway ment of experiences in order to reduce anx-
based around MDT consensus has been pro- iety and depression.105 A randomised control
posed due to restrictions around undertak- trial (RCT) of mindfulness-based stress re-
ing laryngoscopy during the Covid-19 pan- duction, found improved quality of life and
demic.96 Management approaches remain to less perceived stress across 42 patients with
be validated for ILO in the setting of difficult mild, moderate and severe asthma (compared
asthma. MDT approaches revolving around against a control intervention).106 The feasibil-
the input of a speech and language therapist ity and positive impact of delivering such in-
nevertheless show efficacy and are often the terventions in a group setting has been shown
mainstay of treatment in centres specialising in a recent pilot observational study.107 Cogni-
in this condition.97 These typically employ a tive Behavioural Therapy (CBT) provides an-
multicomponent approach that includes pa- other avenue for the Asthma Psychologist to
tient education, strategies to reduce larynge- support patients with difficult asthma. This
al irritation and tension plus elements of psy- focuses on stopping negative thought cycles
chological and physiotherapy support where associated with an overwhelming complex is-
appropriate. sue such as difficult asthma by breaking that
down into smaller parts that be more readi-
ly addressed. A Cochrane review of CBT in
persistent asthma demonstrated some
