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IntroductionSpecialist speech and language therapy (SLT) has an established role in the treatment of chronic refractory cough. Therapy delivered in a group format has been shown previously to reduce cough severity1. Attendance in person, however, was interrupted by the coronavirus pandemic. This work reports the effectiveness of a virtual, SLT-led cough therapy group (VCTG).MethodEligible patients referred between January-June 2022 from two specialist cough clinics were invited to join VCTG. The group comprised of four sessions at weekly intervals, with a review at week 10. Group size ranged from 3–8 patients;sessions were run via Microsoft Teams. Patients were asked to complete a visual analogue scale (VAS) for cough severity (anchored by ‘no cough’ to ‘worst cough ever’) and self-belief in controlling their symptoms (‘no self-belief’ to ‘complete self-belief’) and the Leicester Cough Questionnaire (LCQ) at weeks 1, 4 and 10. Patients had the opportunity to provide qualitative feedback on their experience in the group.ResultsTwenty-eight patients (n=24 female, 85.7%) aged between 29 and 78 (M=55) attended VCTG. Fifteen patients completed all outcome measures at weeks 1 and 4;data from week 10 are pending. From weeks 1 to 4, there was a reduction in mean cough severity (63.2% to 36.6%), an increase in mean self-belief (37.3% to 60.2%), and an increase in LCQ scores (9.6 to 12) following group attendance. The predominant theme from qualitative feedback was the value of meeting other people with CRC and not feeling alone.ConclusionsOnline delivery of group SLT sessions is effective in improving symptoms of CRC and in facilitating valuable support between group members. Patients felt better equipped to control their cough with reductions in cough severity and in the impact on psychosocial and physical wellbeing. Future work is needed to optimise completion of outcome measures and to examine long-term maintenance of improved symptom control.ReferencesSelby J, Bailey E, Gillies F, Hull JH. Time to re-group: a novel approach to the delivery of speech and language therapy for chronic refractory cough. Thorax 2017;72:A141.
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P57 Figure 1Cough severity analogue scale (a) and cough-specific health status LCQ (b) ranges for Pateint Global Impression of Severity categories[Figure omitted. See PDF]ConclusionThe PGI-S scale is a simple tool that characterises cough severity in a format familiar to clinicians, and allows comparisons with other conditions. The PGI-S has a strong relation with validated cough measures such as VAS and LCQ. Future studies should investigate the reproducibility and clinically important threshold for change of the PGI-S.
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P142 Table 1Baseline characteristics and exercise measurements Post COVID-19 BPD (N = 20) Non-COVID BPD (N = 20) Healthy controls (N = 15) BASELINE CHARACTERISTICS Age/years 41 (10) 49 (14) 50 (18) Gender M:F 6:14 6:14 9:6 BMI (kg/m2) 25 (4) 26 (5) 25 (4) Nijmegen score (/64) 23 (12–44) 23 (14–41) - FEV1 (% pred) 111 (13) 107 (16) 96 (6) FVC (% pred) 118 (14) 114 (16) 107 (12) FEV1/FVC Ratio 80 (6) 78 (6) 75 (12) Resting SpO2 (%) 98 (95–100) 99 (94–100) 97 (96–99) Resting HCO3 − (earlobe) (mmol/L) 24 (5) 22 (3) 24 (2) Resting PaCO2 (kPa) 4.4 (0.8) 4.3 (0.7) 4.7 (0.5) Resting BORG CR-10 dyspnoea (/10) 0.7 (0.8) 1.4 (1.3) 0.2 (0.6) PEAK exercise CPET Variables Duration of test (minutes) 10 (4) 9 (2) 15 (3) Main reason cited for exercise cessation Legs = 6 Legs = 8 Legs = 6 Breathing = 14 Breathing = 12 Breathing = 4 BORG CR-10 dyspnoea (/10) End=5.3 (2.3) End=4.2 (1.5) End=4.1 (1.7) Peak VO2 (L/min) 2.18 (0.87) 1.52 (0.62) 2.77 (1.22) Peak VO2 (% predicted) 106.5 (33.1) 79.8 (17.5) 124.8 (27.3) Peak VO2 (mL/min/kg) 29.6 (7.6) 20.7 (7.1) 37.8 (14.8) Peak Heart Rate (beats/min) 170 (12.6) 141 (26) 167 (15) Heart Rate Reserve (beats/min) 20 (19) 30 (20) 2 (13) Peak VE (L/min) 89 (26) 60 (27) 96 (35) Peak Tidal Volume (L) 2.6 (1.3) 1.86 (0.88) 2.37 (0.71) Peak Breathing Frequency (/min) 43 (23) 31 (9) 33 (8) Peak SpO2 (%) 97 (93–100) 99 (94–100) 95 (73–98) PEAK exercise gas exchange values PaO2 (kPa) 13.3 (3.2) 13.8 (1.2) 13.7 (1.2) PaCO2 (kPa) 4.4 (1.1) 4.2 (0.7) 4.1 (0.7) PETCO2 (kPa) 4.4 (0.6) 4.3 (0.5) 4.8 (0.8) P(A-a)O2 difference (kPa) 2.8 (1.2) 2.1 (0.9) 2.6 (0.9) P(a-ET)CO2 difference (kPa) - 0.10 (0.25) −0.09 (0.37) −0.35 (0.53) Approximate entropy (ApEn) of ventilatory variables during incremental exercise ApEn Tidal Volume 1.61 (0.05) 1.28 (0.23) 1.02 (0.29) ApEn Breathing Frequency 1.40 (0.10) 1.41 (0.20) 1.32 (0.21) ApEn Minute Ventilation 1.22 (0.11) 0.97 (0.30) 0.65 (0.23) Data shown as mean (SD) or median (range);M:F: Male:Female;BMI: body mass index;FEV1: forced expiratory volume in the first second;FVC: forced vital capacity;SpO2;oxygen saturation;CPET: cardiopulmonary exercise test;VO2: oxygen consumption;VE:ConclusionsPost COVID BPD can be characterised by application of non-linear statistical modelling of exercise ventilatory data. This approach now needs further validation to facilitate application in automated CPET equipment, to identify and highlight this important differential diagnosis.
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P77 Table 1 n = 50 (%) Age (years) 44 Sex Male 9 18 Female 41 82 BMI (kg/m2) 30.7 On high dose inhaled corticosteroids (ICS) 49 98 No. of patients on at least 5mg daily prednisolone 19 38 No. of patients who had 2 or more courses of prednisolone 29 58 Ethnicity Caucasian 39 78 Black 1 2 Other 10 20 ConclusionsDomiciliary spirometry in a cohort of patients with a presumed diagnosis of difficult-to-treat asthma, enabled just over one in every ten patients to commence asthma biologic therapies, whilst allowing patients to limit extensive travel and remain out of the hospital environment. Further work is warranted to ensure feasibility, cost-effectiveness and patient compliance.