1284 Young people with dysfunctional breathing problems: the impact of a novel multi-disciplinary paediatric breathing clinic

Abstract

<h3>Aims</h3> Dysfunctional breathing (DB) has significant impacts on the quality of life, emotional well-being and functioning of children and young people, with the most common symptoms reported being shortness of breath and chest discomfort.¹ Symptoms are often mistaken for asthma, although asthma and DB commonly occur together.² A young person’s perceptions of breathlessness and the level of anxiety they experience in relation to this can further complicate their presentation. The multifaceted nature and complexity of dysfunctional breathing problems in children and young people led to the development of a multidisciplinary paediatric breathing clinic run jointly by a specialist physiotherapist and clinical psychologist at a large teaching hospital in London. This study explored the impact of this new service on the symptoms, emotional well-being, and quality of life of those who attended. <h3>Methods</h3> Children and young people were referred to the clinic when their history was highly suggestive of a breathing pattern disorder (BPD) or exercise-induced laryngeal obstruction (EILO) as evaluated by an experienced paediatric respiratory consultant. Referrals were made between 2017 and 2020. Following referral children and young people were jointly assessed by a specialist physiotherapist and clinical psychologist. Interventions included education on the biopsychosocial model of breathing, breathing retraining, cognitive-behavioural strategies to address anxiety and advice on diet and exercise. Young people were asked to complete a set of self-report questionnaires at assessment (time point 1) and discharge (time point 2): • Nijmegen Scale • Hospital Anxiety and Depression Scale (HADS) • Pediatric Quality of Inventory (PEDS-QL) <h3>•</h3> <h3>Results</h3> 79 young people were referred to the breathing clinic within the study period. Within this cohort, there were more girls (n = 55) than boys (n = 24). The mean age at referral was 13 years (range = 9-18) and mean number of sessions provided was 4. On examination of the self-report questionnaires at assessment (time point 1), 57% (n = 45) of young people were found to have Nijmegen scores of 20 or over (the standard cut-off in adults). 37% of young people (n = 29) were found to have HADS anxiety scores at or above the clinical threshold and 54% of young people (n = 43) reported quality of life scores at least 1 standard deviation below the norm.³. Analysis of complete data at assessment (time point 1) and discharge (time point 2) revealed statistically significant improvements in Nijmegen scores (p &lt; 0.001), HADS anxiety scores (p &lt; 0.005) and quality of life scores (p &lt; 0.05). <h3>Conclusion</h3> Dysfunctional breathing problems originate and are maintained by multiple factors and, consequently, children and young people benefit from a multidisciplinary approach to their breathing difficulties. Multidisciplinary intervention was associated with significant reduction in physiological and psychological symptoms and improvements in young people’s self-reported quality of life. <h3>References</h3> Paediatric Respiratory Reviews, N. Barker &amp; M. Everard Frontiers in Paediatrics, G. J. Connett &amp; M. Thomas Health and Quality of Life Outcomes, P. Upton et al.