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Background and objective: Multidisciplinary team (MDT) clinics use an integrated approach to individualize care of complex medical conditions. Vocal cord dysfunction (VCD) is a challenging condition that is likely to benefit from MDT clinics but this has not been researched. Method(s): A prospective observational cohort study of a novel VCD MDT clinic was conducted in patients with suspected VCD. Relevant questionnaires, medical history, physical examination, spirometry, dynamic computerized tomography (CT) larynx and laryngoscopy were utilized and patients were allocated to treatment pathways depending on putative diagnosis. Speech pathology intervention with laryngeal retraining (LR) was offered and if LR therapy failed botulinum toxin injection was offered. Primary outcome was reductions in healthcare utilization. Result(s): Overall, 80 consecutive patients were included in analyses. A definitive diagnosis of VCD was made in 56 of 80 (70%) patients. After LR (n = 35), emergency department (ED)/hospital admissions declined significantly in the subsequent 12 months (P = 0.001). General practice visits also reduced (P < 0.001). Botulinum toxin injections were administered in 21 patients unresponsive to LR therapy and both general practice and ED/hospital visits declined (P < 0.001 and P = 0.01, respectively) after injection. Conclusion(s): A multidisciplinary approach to VCD confers benefit and can be used to allocate appropriate management leading to a reduction in healthcare utilization.Copyright © 2019 Asian Pacific Society of Respirology

BACKGROUND AND OBJECTIVE: Multidisciplinary team (MDT) clinics use an integrated approach to individualize care of complex medical conditions. Vocal cord dysfunction (VCD) is a challenging condition that is likely to benefit from MDT clinics but this has not been researched. METHODS: A prospective observational cohort study of a novel VCD MDT clinic was conducted in patients with suspected VCD. Relevant questionnaires, medical history, physical examination, spirometry, dynamic computerized tomography (CT) larynx and laryngoscopy were utilized and patients were allocated to treatment pathways depending on putative diagnosis. Speech pathology intervention with laryngeal retraining (LR) was offered and if LR therapy failed botulinum toxin injection was offered. Primary outcome was reductions in healthcare utilization. RESULTS: Overall, 80 consecutive patients were included in analyses. A definitive diagnosis of VCD was made in 56 of 80 (70%) patients. After LR (n = 35), emergency department (ED)/hospital admissions declined significantly in the subsequent 12 months (P = 0.001). General practice visits also reduced (P < 0.001). Botulinum toxin injections were administered in 21 patients unresponsive to LR therapy and both general practice and ED/hospital visits declined (P < 0.001 and P = 0.01, respectively) after injection. CONCLUSION: A multidisciplinary approach to VCD confers benefit and can be used to allocate appropriate management leading to a reduction in healthcare utilization.

Background: Allergy to the venom of native Myrmecia pilosula (Jack Jumper ant [JJA]) is a common cause of anaphylaxis in south eastern Australia. Allergen immunotherapy has clearly been demonstrated to improve this clinical allergy by significantly reducing systemic allergic reactions. Due to the inherent reactivity of the venom and severity of clinical reactions, specialised treatment centres deliver this non-commercial pharmaceutical therapy. The Victorian State Centre for Insect Venom Immunotherapy commenced in 2016 to provide this previously unavailable JJA immunotherapy service to Victorians. Aim(s): To report on the demographics of patients referred to the service for consideration of further treatment for JJA allergy. Method(s): Referral, Waiting List and Admission Data were collated and analysed to characterise the patients of the service since commencement in March 2016, until April 2018. Result(s): 247 patients were reviewed for consideration for treatment, of which 204 (83%) were waitlisted for treatment. There is a bi-modal distribution of ages peaking in mid-teenage years and early 60's, with an approximately even Male: Female preponderance. There is a paucity of referred patients aged 20-50 years, which is more pronounced in those commenced on immunotherapy, particularly in males. 100 patients had been initiated into regular treatment as of April 2018. The distribution of patient's nominated residence is throughout south eastern Victoria. Conclusion(s): Although JJA venom immunotherapy is clearly an "indemand" service-the age demographics of referred patients are significantly different to that of the underlying base population. This may be due to differences in age-related manifestation of clinical allergy, healthseeking behaviours, or other unrecognised structural factors-and warrants further consideration for the provision of this state-wide service.

Background: Allergy to penicillin is commonly reported in the community. However, the majority of patients are not allergic when formally tested. In low risk patients, rapid allergy testing has been performed with skin prick/intradermal or direct oral challenge in an outpatient and Emergency Department setting. However, a direct oral challenge in acute hospital inpatient has not been reported. Aim(s): To access the feasibility and safety of rapid penicillin allergy delabelling with direct oral challenge in admitted acute general medical patients. Method(s): Patients admitted to a general medicine unit were screened for a history of penicillin allergy by unit pharmacists. A detailed history was obtained on patients with a self-reported penicillin allergy to assess suitability for a direct oral challenge: including current clinical status, and pretest probability based on the Australian Society of Allergy and Clinical Immunology (ASCIA) Guidelines. Suitable patients where challenged with a single 250mg Amoxicillin oral dose, followed by a 3 days course of 250mg Amoxicillin TDS. Result(s): 1808 patients were admitted to a general medicine unit from February to June 2018. 181 (10%) patients had a documented penicillin allergy. Rash (45%) is most commonly reported followed by unknown/non-specific reaction (21%) and gastro-intestinal symptoms (10%). Only 28 (16%) of patients met criteria for high pre-test probability of reaction. 35 (19%) patients were recruited to a challenge. 34 patients tolerated the challenge without any reactions. Only 1 patient reported a rash. 13 patients had been de-labelled from June 2017 to February 2018 using the same protocol, resulting in total of 47 patients successfully de-labelled since June 2017. Data collection is ongoing. Conclusion(s): Penicillin allergy de-labelling with a direct oral challenge in an acute hospital inpatient setting is likely safe and feasible. This approach may improve patient outcome with better anti-microbial usage

Introduction/Aim: Vocal cord dysfunction (VCD) causes vocal cord narrowing during inspiration resulting in airflow obstruction and may contribute to breathlessness in asthma. Treatment is difficult, however speech therapy and botulinum toxin (Botox) injections can be effective. As part of a multidisciplinary VCD clinic, patients undergoing treatment were evaluated for symptom and healthcare outcomes. Method(s): Patients with confirmed VCD (n=35) were assessed. VCD was diagnosed by detection (CT larynx and/or laryngoscopy) of inspiratory paradoxical vocal cord movement (PVCM) on at least one occasion. Patients were then treated with speech therapy (n=35) and if this failed with botulinum toxin injection (n=21). They were assessed pre and post treatment. Patient symptoms were evaluated using standardised asthma, dysfunctional breathing and VCD questionnaires (ACT ACQ, Nijmegen, VCDQ). Health care outcomes were assessed by questionnaire to determine emergency department (ED) and general practitioner (GP) visits in the year prior to and after treatment. Result(s): There were no significant differences in the standardised questionnaires post speech therapy (ACQ: p=0.19; ACT: p=0.28; VCDQ: p=0.66; Nijmegen: p=0.68). Although GP visits were not significantly reduced post treatment (p=0.07), ED visits were significantly reduced post speech therapy (p=0.01). The 21 patients who had botulinum toxin injection had a significant reduction in GP visits (p=0.05) but no reduction in ED visits (p=0.11). There was also no significant difference in questionnaires (ACQ: p=0.13; ACT: p=0.14; VCDQ: p=0.66; Nijmegen: p=0.37). Conclusion(s): Speech therapy and botulinum toxin injection did not improve patient symptom scores linked to asthma and VCD. However, important health outcomes (GP visits and ED admissions) were reduced. The reasons for the discordance between symptoms and health outcomes are unclear.

Introduction/Aim: Vocal cord dysfunction (VCD) often accompanies asthma. Effective treatment of VCD may improve lung function, especially measures of airway resistance. As part of a multidisciplinary VCD clinic, patients with confirmed VCD (via endoscopy and/or CT larynx) were evaluated before and after speech therapy and botulinum toxin injection. Method(s): Patients with confirmed VCD (n=35) were assessed. Diagnosis of VCD was based on detection of inspiratory paradoxical vocal cord movement (PVCM) on at least on occasion. Pre and post spirometry were done, we also conducted resistance measurements and measured lung volumes via body plethysmography before and after treatments. Results were compared using paired t-tests. Result(s): Speech therapy was provided to 35 patients and botulinum toxin injections were administered to 22 patients. Baseline patient demographics are shown in Table 1. All results reported are post bronchodilator (except LV). There were no significant changes to lung function or resistance measures after either speech therapy or botulinum toxin injection. There were changes in sGaw after both treatments that approached statistical significance. Conclusion(s): Treatment of VCD with speech therapy and botulinum toxin injection do not improve airway function. However, absence of changes in physiology does not preclude improvements in symptoms and other features of VCD. (Table presented).