Impact of respiratory speech and language therapy on symptoms in vocal cord dysfunction

Introduction: Our specialist multidisciplinary Airways Service manages patients with vocal cord dysfunction (VCD), principally with respiratory speech and language therapy (rSLT). The VCDQ (Fowler 2015) is the first validated questionnaire for use in VCD, with 12 statements covering a broad range of impacts and symptoms. Aim: To determine the effect of treatment on each VCDQ statement and establish where rSLT has most impact. Methods: We included retrospective (Sept 2015 - Jan 2016) data from patients who had i) endoscopically diagnosed VCD; ii) completed rSLT treatment; and iii) pre & post VCDQ data. Results: Sixteen patients had full data sets. All patients reported clinical improvements. There was overall improvement in VCDQ from median (range) 46 (20-60) pre to 38 (12-50) post rSLT (Wilcoxon9s signed rank p=0.017). Of the 12 statements, items 10 (I am frustrated that my symptoms have not been understood correctly) and 12 (the attacks impact on my social life) improved the most [3.0 (1-5) to 1.0 (1-4), p=0.001] and [4.0 (1-5) to 3.0 (1-5), p=0.001 respectively]. Improvements in item 2 (I feel I can9t get breath past a certain point in my throat/upper chest because of restriction) and 3 (my breathlessness is usually worse when breathing in) were nearly statistically significant [4.0 (1-5) to 3.0 (1-5), p=0.062] and [4.0 (1-5) to 3.0 (1-5), p=0.077 respectively]. Conclusions: Management of VCD with rSLT is beneficial. This preliminary analysis suggests it has the most significant impact on psychosocial issues and may also have physical benefits for symptoms. We acknowledge larger numbers are required to guide future therapeutic refinements.