Introduction As part of our tertiary multi-disciplinary complex breathlessness service we run a weekly ‘one-stop assessment day’ for new referrals. Referral requests include assessment of refractory breathlessness felt due to inducible laryngeal obstruction (ILO) and/or dysfunctional breathing. Patients undergo clinical history and evaluation, spirometry, fractional exhaled nitric oxide (FENO), blood testing and laryngoscopy (with challenge if appropriate).

Aims To evaluate initial clinical plans of those attending one-stop assessment days and understand the prevalence and type of medical comorbidities.

Methods Patient demographics and clinical data were retrospectively collated from clinical records of individuals who attended for assessment between November 2016 and June 2017.

Results Full assessments were available for 79 patients [72% female; mean (SD) age 45.6 (13.6) years; FEV₁ (n=40) 2.6 (0.7) L; FVC (n=40) 3.3 (0.9) L; FENO (n=33) 39.0 (41.2) ppb; blood eosinophils (n=68) median (range) 0.2 (0.1–2.9) x10⁹ cells/ml]. Fifty two percent had endoscopically confirmed inspiratory ILO, and of these 15% had an associated dysfunctional breathing pattern. Initial clinic plans included instigation of medical treatment (n=12), further investigations of untreated co-morbidities (n=33), speech and language therapy treatment (n=30), physiotherapy assessment and treatment (n=9) and onward referral to non-respiratory specialists (n=5). Of those requiring further investigation 73% were asthma related and 21% were for reflux. Medical treatments instigated were mainly related to asthma or bronchiectasis (92%). Secondary analysis of those needing further investigation or medical treatment revealed 39% had inspiratory laryngeal obstruction, 13% had exaggerated expiratory closure, and 23% had noted laryngeal hypersensitivity alone.

Conclusion There is a significant proportion of individuals who have untreated or under investigated co-morbidity (predominantly asthma) when referred for specialist complex breathlessness assessment. Those with untreated disease demonstrated abnormal responses in the upper airway and further support the relationship between ILO and asthma. Optimised medical intervention is important to ensure any aggravants of secondary diagnoses (e.g., ILO) are addressed adequately and their impact is minimised.